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Advanced Sleep & Breathing Disorders
General Business Office
1160 E. Jericho Turnpike Suite 12
Huntington, NY 11743

ph: 631-676-3784
fax: 631-676-3776

SELF Sleep ANALYSIS

Epworth Sleepiness Scale

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.

SituationChance 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.

____

How often do you:

  • feel irritable or sleepy during the day?
  • have difficulty staying awake when sitting still, such as when watching television or reading?
  • fall asleep sometimes while driving?
  • have difficulty paying attention or concentrating at work, school, or home?
  • perform below your potential in work, school or sports?
  • often get told by others that you look tired?
  • have difficulty with your memory?
  • react slowly?
  • have emotional outbursts?
  • feel like taking a nap almost every day?
  • require caffeinated beverages to keep going? 

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

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Advanced Sleep & Breathing Disorders
General Business Office
1160 E. Jericho Turnpike Suite 12
Huntington, NY 11743

ph: 631-676-3784
fax: 631-676-3776