Patient Info

EP WORTH SCALE

In contrast to just feeling tired, how likely are you to doze off or fall asleep in the following situation? If you have not done some of these things recently, think about how they may have affected you in the past? Use the following scale to circle the most appropriate number for each situation.

0 = Would never doze 1 = Slight chance of dozing 2 = Moderate chance of dozing 3 = high chance of dozing

Situation

Chance of Dosing


Sitting and reading
  • 0
  • 1
  • 2
  • 3
Watching tv
  • 0
  • 1
  • 2
  • 3
Sitting inactive in a public place (i.e. theatre)
  • 0
  • 1
  • 2
  • 3
As a passenger in a car an hour without break
  • 0
  • 1
  • 2
  • 3
Lying down to rest in the afternoon
  • 0
  • 1
  • 2
  • 3
Sitting and talking to someone
  • 0
  • 1
  • 2
  • 3
Sitting quietly after lunch without alcohol
  • 0
  • 1
  • 2
  • 3
In a car ,wile stopped for a few minutes in traffic
  • 0
  • 1
  • 2
  • 3

Total:_____________