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Sleep Questionnaire

The Epworth Sleepiness Scale

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 way of life in recent times. Even if you have not 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 - No chance of dozing   1 - Slight chance of dozing   2 - Moderate chance chance of dozing   3 - High chance of dozing

____  Sitting and reading                                                                     

 ____ Watching TV                                                                              

 ____ Sitting, inactive in a public place like a theater or meeting                  

 ____ As a passenger in a car for one hour without a break                         

 ____ Lying down to rest in the afternoon when circumstances permit                                

 ____ Sitting and talking to someone                                                        

 ____ Sitting quietly after a lunch without alcohol                                      

 ____ In a car while stopped for a few minutes in traffic  

 ____ TOTAL     

1-6   You are getting enough sleep
7-9   Your score is average
>10  Discuss this with your physician

For more information regarding Sleep Disorders, please call 706-320-2741

 

  St. Francis Hospital | Columbus, Georgia 31904 | (706)-596-4000
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