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VIDEO
by
cpaptalk.com
**Fast internet connection required

THE EPWORTH SLEEPINESS SCALE

How likely are you to doze off or fall asleep in the situations described in the box below, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven't done some of these things recently, try to work out how they would have affected you. Fill out this form and we will contact you on our analysis of your sleep data.

Name (required): Date:

email (required):

Sex: Male Female Your age (Yrs):

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.…………………………………………………..
Watching TV……………………………………………………
Sitting, inactive in a public place (eg a theatre or a 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 a lunch without alcohol………………………..
In a car, while stopped for a few minutes in the traffic…………...
TOTAL……  

(The numbers for the eight situations are added together to give a global score between 0 and 24)

      

Thank you for your co-operation

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