Epworth Sleepiness Questionnaire

We have included a questionnaire below to help us gain an understanding of how likely you are to doze off or fall asleep in the following situations.

We encourage you to bring your questionnaire with you to your next appointment.

Download Epworth Sleepiness Questionnaire

Alternatively, you can simply fill out the form below.


Use the following scale to choose the most appropriate number for each situation:

0 = would never doze or sleep.
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping

Situation

Chance of Dozing or Sleeping

Sitting and reading
Watching TV
Sitting inactive in a public place
Being a passenger in a motor vehicle for an hour or more
Lying down in the afternoon
Sitting and talking to someone
Sitting quietly after lunch (no alcohol)
Stopped for a few minutes in traffic while driving
Total score (add the scores up)
(This is your Epworth score)
Weight (kg)
Height (cm)
Shirt/Collar Size (cm)

Name *

Email *