Advanced Sleep & Breathing Disorders
General Business Office
1160 E. Jericho Turnpike Suite 12
Huntington, NY 11743
ph: 631-676-3784
fax: 631-676-3776
info
The Epworth Sleepiness Scale is used to determine the level of daytime sleepiness.
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
Print this page, fill in your answers and see where you stand.
| 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) If you score 10 or more on this test, you might need to see your health care professional to discuss your results from this quiz. | ____ |
Sleep Survey
This survey is not intended as medical advice. Add ONLY the YES points up and you can see your score at the bottom of the page.
Have you ever fallen asleep or nodded off while driving? ____ 6 points
Have you had a weight gain and found it difficult to lose? ____ 2 points
Have you been told that you stop breathing while you sleep? ____8 points
Do you awaken suddenly with shortness of breath, gasping
or with a racing heart? ____6 points
Do you ever feel excessively sleepy during the day? ____4 points
Has anyone ever told you that you snore while you sleep? ____4 points
Have you been diagnosed with high blood pressure? ____2 points
Do you kick or jerk your legs while sleeping? ____3 points
Do you feel burning or tingling in your legs upon awakening? ____3 points
Do you ever have trouble falling asleep? ____4 points
Do you wake up with headaches at night or in the morning? ____3 points
Do you have trouble staying asleep once you fall asleep? ____4 points
Do you have history of heart disease? ____6 points
____ Total points
Sleep Apnea Risk Analysis Score
0-7 Low 8-11 Moderate
12-15 High 16+ Severe
Advanced Sleep & Breathing Disorders
General Business Office
1160 E. Jericho Turnpike Suite 12
Huntington, NY 11743
ph: 631-676-3784
fax: 631-676-3776
info