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SEARS TOWER - CHICAGO

EPWORTH SLEEPINESS SCALE

Please print the following questionnaire, complete it, and bring it to the consultation with your Sleep Physician.

The following questionnaire will help you measure your general level of daytime sleepiness. Answers are rated on a reliable scale called the Epworth Sleepiness Scale (ESS) - the same assessment tool used by sleep experts worldwide. This test was developed by Dr. Murray Johns at Epworth Hospital in Melbourne, Australia in 1991. Each item describes a routine daytime situation. Use the scale below to rate the likelihood that you would doze off or fall asleep (in contrast to just feeling tired) during that activity. If you haven't done some of these things recently, consider how you think they would affect you. Please note that this scale should not be used to make your own diagnosis. It is intended as a tool to help you identify your own level of daytime sleepiness, which can be a symptom of a sleep disorder.

Use the following scale to answer the questions:
0 = would never doze 1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Sitting and Reading
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing 
3 = high chance of dozing

Watching Television
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing                   
3 = high chance of dozing

Sitting inactive in a public place, for example, a theater or a meeting
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing
3 = high chance of dozing

As a passenger in a car for an hour without a break
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing 
3 = high chance of dozing

Lying down to rest in the afternoon
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing
3 = high chance of dozing

Sitting and talking to someone
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing
3 = high chance of dozing
Sitting quietly after lunch when you've had no alcohol
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing 
3 = high chance of dozing

In a car while stopped in traffic
0 = would never doze  1 = slight chance of dozing  2 = moderate chance of dozing 
3 = high chance of dozing

______TOTAL SCORE

Sleep is a health issue; without proper sleep, the human body cannot function well. Good sleep helps ward off illnesses, helps maintain healthy skin, bones, and muscles and helps to balance hormones and other important brain and body chemicals.  If your total score is 10 or higher, review it with your doctor or other health care provider.
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