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Epworth Sleepiness Scale Form: Total Score

Sleep and Epsworth Scale

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Williams Amadi
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794 views1 page

Epworth Sleepiness Scale Form: Total Score

Sleep and Epsworth Scale

Uploaded by

Williams Amadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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EPWORTH SLEEPINESS SCALE FORM

Instructions: Be as truthful as possible. Print the form. Read the situation in the first column; select your
response from the second column; enter that number in the third column. Total all of the entries in the
third column and enter the total in the last box.

Situation
Sitting and Reading

Watching Television

Sitting inactive in a public place, for


example, a theater or a meeting
As a passenger in a car for an hour
without a break

Lying down to rest in the afternoon

Sitting and talking to someone

Sitting quietly after lunch when youve


had no alcohol
In a car while stopped in traffic

Responses

Score

0 = would never doze


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

TOTAL SCORE
A score of 10 or greater indicates a possible sleep disorder. Take the completed form to your doctor.
Provided courtesy of Narcolepsy Network, Inc.
110 Ripple Lane
North Kingston, RI 02852
Toll free 888-292-6522
Tel 401-667-2523
Fax 401-633-6567
E-mail: [email protected]
Website: www.narcolepsynetwork.org
The Associated Professional Sleep Societies, Westchester, IL. Johns MW. A new
method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep
1991;14(6):540-545.

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