Epworth Sleepiness Scale Form

Instructions:

1. Be as truthful as possible.
2. Read the situation in the first column; select your response from the second column.
3. The score will calculate automatically.
4. A score of 10 or greater indicates a possible sleep disorder.

Additional Information
Neck circumference (inches)

Situation	Response
Sitting and reading	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
Watching television	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
Sitting inactive in a public place (theatre, meeting)	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
As a passenger in a car for an hour without a break	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
Lying down to rest in the afternoon	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
Sitting and talking to someone	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
Sitting quietly after lunch (no alcohol)	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing
In a car while stopped in traffic	0 – Would never doze 1 – Slight chance of dozing 2 – Moderate chance of dozing 3 – High chance of dozing