Epworth Sleepiness Scale   Please enter the information below to help us help you with your sleep difficulties.   Name:   Age:   Gender: Male Female Doctor: e-mail:   How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? Select the CHANCE OF DOZING response that most appropriately applies to each SITUATION below, then click the ANALYZE button below to see the results of analyzing your responses. SITUATION   CHANCE OF DOZING Sitting and reading.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing Watching television.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing Sitting inactively in a public place.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing As a passenger in a car for about an hour.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing Lying down to rest in the afternoon.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing Sitting and talking to someone.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing Sitting quietly after lunch without alcohol.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing In a car while stopped for a few minutes.   Would never doze Slight chance of dozing Moderate chance of dozing High chance of dozing Copyright © 1990 M. W. Johns The Epworth Sleepiness Scale is reproduced with the permission of Dr. Murray W. Johns. Provided by LungStar Diagnostics   ·   (972) 422-4800