Epworth Sleepiness Scale Epworth Sleepiness Scale Patient first name(Required)Last name(Required)Email(Required) Enter Email Confirm Email Date of Birth(Required)Date(Required) MM slash DD slash YYYY How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently,try to work out how they would have affected you.Use the following scale to mark the most appropriate box for each situation (M.W.Johns, Sleep 1991).0 = no chance of dozing1 = slight chance of dozing2 = moderate chance of dozing3 = high chance of dozingSitting and reading 0 1 2 3 Watching TV 0 1 2 3 Sitting inactive in a public place (i.e. theater or meeting) 0 1 2 3 As a passenger in a car for an hour without a break 0 1 2 3 Lying down to rest in the afternoon when circumstances permit 0 1 2 3 Sitting and talking to someone 0 1 2 3 Sitting quietly after a lunch without alcohol 0 1 2 3 In a car, while stopped for a few minutes in traffic 0 1 2 3 If your total score is greater than 9, this could indicate the presence of a sleep disorder. Please ask your neurologist if a sleep study would be helpful in evaluating your symptoms.Rev 7.13.2016EmailThis field is for validation purposes and should be left unchanged.