Epworth Sleepiness Scale

Epworth Sleepiness Scale

Name:____________________________________________

Date:_________________________

Your age: (Yr)__________________

Your sex:  Male  Female

How likely are you to doze off or fall asleep in the situations described below, in contrast to feeling just tired?

This refers to your usual way of life in recent times.

Even if you haven’t done some of these things recently try to work out how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:-

0 = would never doze

1 = Slight chance of dozing

2 = Moderate chance of dozing

3 = High chance of dozing

Situation

Chance of Dozing

Sitting and reading _______
Watching TV _______
Sitting, inactive in a public place (e.g. a theater or a meeting) _______
As a passenger in a car for an hour without a break _______
Lying down to rest in the afternoon when circumstances permit _______
Sitting quietly after a lunch without alcohol _______
In a car, while stopped for a few minutes in the traffic _______
TOTAL _______

Score:

0-10     Normal

10-12   Borderline

12-24   Abnormal

 

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3855 West 7800 South
Suite 250
West Jordan, Utah 84088
Phone: 801.282.5839 Email: info@holtdentalcare.net

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