The Epworth Sleepiness Scale.

The Epworth Sleepiness Scale is widely used in the field of sleep medicine as a subjective measure of a patient's sleepiness. The test is a list of eight situations in which you rate your tendency to become sleepy on a scale of 0, no chance of dozing, to 3, high chance of dozing.

If you have been reffered to our office by your physician for sleep disordered breathing (SDB) or obstructive sleep apnea (OSA) oral appliance therapy, please complete the Epworth Sleepiness Scale below. Additionally, please bring your most recent polysomnogram (PSG) with you to your initial appointment.

How Sleepy Are You?

How likely are you to doze off or fall asleep in the following situations? You should rate your chances of dozing off, not just feeling tired. Even if you have not done some of these things recently try to determine how they would have affected you. For each situation, decide whether or not you would have:

  • No chance of dozing = 0

  • Slight chance of dozing = 1

  • Moderate chance of dozing = 2

  • High chance of dozing = 3

Personal Information
Name *
Name
Phone Number *
Phone Number
Date of Birth *
Date of Birth
How likely are you to doze off or fall asleep in the following situations?
[1] Sitting and Reading *
[2] Watching Television (TV) *
[3] Sitting inactive in a public place (i.e.: a theatre or 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 of traffic *