Epworth Sleepiness Scale

For each of the following questions, answer how likely you are to fall asleep/doze off:

0 = NEVER ….. 1 = SLIGHT CHANCE ….. 2 = MODERATE CHANCE ….. 3 = HIGH CHANCE

Name

First Name

Last Name

Phone

(###)

###

####

Preferred contact

ESS 1

1. Sitting and reading

ESS 2

Watching TV

ESS 3

Sitting inactive in a public place

ESS 4

As a car passenger for 1 hour without a break

ESS 5

Lying down to rest in the afternoon

ESS 6

Sitting and talking to someone

ESS 1

Sitting quietly after lunch without alcohol

ESS 8

In a stopped car for a few minutes in traffic

Total

Please add up the total of your responses and enter it below