Epworth Sleepiness Scale Questionnaire 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 0 1 2 3 Watching Television 0 1 2 3 Sitting inactive in a public place (For example, a theater or meeting) 0 1 2 3 As a passenger in a car for one hour without a break 0 1 2 3 Sitting down quietly after lunch with no alcohol 0 1 2 3 Lying down to rest in the afternoon 0 1 2 3 Sitting and talking to someone 0 1 2 3 In a car, while stopped for a few minutes in traffic 0 1 2 3 Total: Scoring: 0-7 = ok | 8-9 = Average Sleepiness | 10-15 Maybe Excessive Sleepiness | 16-24 = Excessively Sleepiness and Should Consider Medical Attention Submit Form Your request has been sent -- we will be in contact with you shortly. There was an error! Please phone our office.