Table 10.

Epworth Sleepiness Scale* (reproduced with permission from Johns241)

* Scores of >10 are consistent with excessive daytime sleepiness.
Today’s date:_____________Your age (years):__________________
Your sex (male = M; female = F):______________________
How likely are you to doze 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 have not done some of these things recently try to work out how they would have affected you. Use the following scale to 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
SituationChance of dozing
Sitting and reading______
Watching TV________
Sitting, inactive in a public place (e.g., a theater or a meeting)__________
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 a lunch without alcohol__________
In a car while stopped for a few minutes in the traffic__________
Thank you for your cooperation