The Epworth Sleepness Scale

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Patient details:

How likely are you to dose off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times.Even if you hafve not done some of these things recently try to workout how they would have affected you. Use the following scale to choose the most appropriate number of each situation:

0: No chance of dozing
1: Slight chance of dozing
2: Moderate chance of dozing
3: High chance of dozing

1. Sitting and reading

0
1
2
3


2. Watching TV

0
1
2
3


3. Sitting inactive in a public place (e.g a theater of meeting)

0
1
2
3


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

0
1
2
3


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

0
1
2
3


6. Sitting and talking to someone

0
1
2
3


7. sitting quietly after a lunch without alcohol

0
1
2
3


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

0
1
2
3



I acknowledge for the safety of others that I have provided true and accurate details and I agree that may details can be used for contact tracing.

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