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The Sleep Survey

The Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the situations listed below? This is to test your level of sleepiness during the day. Even if you haven't done some of these things recently, try to work out how each situation would affect you.

Use the following scale to choose the most apporpriate number for each situation:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

It is important that you answer each question as honestly as you can.

Source: Johns M.W. A new method of measuring daytime sleepiness: the Epworth Sleepiness Scale.

* Indicates required information

Please provide the following information to help us best serve you.

First Name
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Instruction

Situation and your best estimate of your chance of dozing based on a scale of 0 to 3.

1. *

Sitting and reading

        
2. *

Watching TV

        
3. *

Sitting, inactive in a public place, such as a theatre or in a meeting

        
4. *

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

        
5. *

Lying down to rest in the afternoon when circumstances permit

        
6. *

Sitting and talking to someone

        
7. *

Sitting quietly after a lunch without alcohol

        
8. *

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

        
 
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