Patient Name:

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is widely used in the field of medicine as a subjective measure of a patient's sleepiness. How likely are you to doze off or fall asleep during the following situations, in contrast to just feeling tired?

For each of the situations listed below, give yourself a score of 0 to 3

0=Would never doze, 1=Slight chance, 2=Moderate chance, 3=High chance

Situation
Sitting and reading
Watching Television
Sitting inactive in a public place (For example, a theater or meeting)
As a passenger in a car for one hour without a break
Sitting down quietly after lunch with no alcohol
Lying down to rest in the afternoon
Sitting and talking to someone
In a car, while stopped for a few minutes in traffic
Total:

Scoring: 0-7 = ok | 8-9 = Average Sleepiness | 10-15 Maybe Excessive Sleepiness | 16-24 = Excessively Sleepiness and Should Consider Medical Attention

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