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Sleep Services

Epworth Sleepiness Scale

Name:                                                  

Please rate the following situations using the 0-3 scale below. Then, add each score. If you score more than 8, show this to your doctor. He/she may want to order a sleep test for you.

In contrast to just feeling tired, how likely are you to doze off or fall asleep in the following situations? (This refers to your usual life in recent times, even if you have not done some of these recently.)

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	0    1    2     3
Watching TV	0    1    2     3
Sitting inactive in a public place (i.e. a theater or meeting)	0    1    2     3
As a passenger in a car for an hour without a break	0    1    2     3
Lying down to rest in the afternoon when circumstances permit	0    1    2     3
Sitting and talking to someone	0    1    2     3
Sitting quietly after lunch without alcohol	0    1    2     3
In a car, while stopped for a few minutes	0    1    2     3

TOTAL:                                   

Halifax Regional Hospital Sleep Study Lab
2204 Wilborn Ave.
South Boston, VA  24592