The Epworth Sleepiness Scale - Click to Download
How likely are you to doze off or fall asleep in the following situations?
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
| Activity | Score |
| Sitting and Reading | _____ |
| Watching TV | _____ |
| Sitting, inactive in a public place (theater, meeting, etc.) | _____ |
| 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 lunch without alcohol | _____ |
| In a car, while stopped for a few minutes in traffic | _____ |
| Total | _____ |
*A score of 9 or above indicates you may be having a problem with daytime sleepiness but below 9 does not necessarily mean that you don't have a problem. See your healthcare professional for advice if you snore, have been told that you awake gasping for breath or if you are sleepy during the day.
Sleep Observer Scale - Click to Download
The following questions relate to the behavior that you have observed in the patient while he/she is asleep. Use the following scale to choose the most appropriate number for each situation:
0=Never
1=Infrequently (1 night per week)
2=Frequently (2-3 nights per week)
3=Most of the time (4 or more nights per week)
| Observed Behavior | Score |
| Loud, irritating snoring | _____ |
| Choking or gasping for air | _____ |
| Pauses in breathing | _____ |
| Twitching / kicking of arms or legs | _____ |
| Snoring requiring separate bedrooms | _____ |
| Falling asleep inappropriately (example: while driving or at meetings) | _____ |
| Total | _____ |
*A score of 5 or greater indicates symptoms which are affecting the health, safety, or quality of life of the observed person.
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