Epworth Sleepiness Scale Sleep Survey

The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness. A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hydgiene and /or need to see a sleep specialist.

Please answer all of the below questions.

How likely are you to fall asleep in the following situations?

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Activity	Score
Sitting and reading
Watching television
Sitting, inactive, in a public place (theater, meeting)
As a passenger in a car for an hour with no break
Laying down to rest in the afternoon, if circumstances permit
Sitting and talking to someone
Sitting quietly after lunch without alcohol
In a car while stopped for a few minutes in traffic

Your score is

If your score was 10 or higher, you may be having a serious problem with daytime sleepiness, which can be caused by sleep apnea. A score below 10 does not necessarily mean that you do not have a problem.

Contact Dr. Siegel right away to discuss your problems with daytime sleepiness.

Print this page and bring it with you to your consultation.

Epworth Sleepiness Scale Sleep Survey

How likely are you to fall asleep in the following situations?

Activity

Score

Sitting and reading

Watching television

Sitting, inactive, in a public place (theater, meeting)

As a passenger in a car for an hour with no break

Laying down to rest in the afternoon, if circumstances permit

Sitting and talking to someone

Sitting quietly after lunch without alcohol

In a car while stopped for a few minutes in traffic

Contact Dr. Siegel right away to discuss your problems with daytime sleepiness.