EPWORTH  SLEEPINESS  SCALE

            NAME  :  ...................................................................

            DATE  :  ..........................................

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.

Choose the most appropriate number for each situation from the following scale : -

                        0  -  would never doze

                        1  -  slight chance of dozing

                        2  -  moderate chance of dozing

                        3  -  high chance of dozing

SITUATION

Sitting and reading                                                             ...............................

Watching television                                                                      ...............................

Sitting inactive in a public place (eg. Cinema, theatre or

                                                                        meeting )            ...............................

As a passenger in a car for an hour without a break               ................................

Lying down to rest in the afternoon when circumstances permit...........................

Sitting and talking to someone                                               ................................

Sitting quietly after lunch without alcohol                         .................................

In a car, while stopped for a few minutes in traffic                ................................

A.C.  Thompson

Queens Hospital  Burton

Sleep Clinic