Epworth Sleepiness Scale Epworth Sleepiness Scale Date* MM slash DD slash YYYY Name* First Last How likely are you to doze off or fall asleep in the following situations? (in contrast to 'just feeling tired'?) This refers to your usual behavior in recent times. Even if you have not done some of these things recently, consider how they would have affected you. Use the following scale to choose the most appropriate number for each situation: Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 1. Sitting and reading* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 2. Watching television* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 3. Sitting inactive in a public place (theatre, meeting, etc)* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 4. As a passenger in a car for an hour without a break* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 5. Lying down to rest in the afternoon when circumstances permit* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 6. Sitting and talking to someone* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 7. Sitting quietly after a lunch w/out alcohol consumption* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 8. In a car while stopped for a few minutes in traffic* Would NEVER doze Slight chance of dozing Moderate chance of dozing High chance of dozing 0 - 10 Normal ; > 10 Insufficient sleep; consider improving sleep hygiene; consultation with a sleep specialist recommended