Sleepiness Assessment

Sleepiness Assessment

How sleepy are you? Fill out this simple questionnaire to find out.
Epworth Sleepiness Scale
Name:*

First NameLast Name
Today's Date:

MonthDayYear
Date
Your age (yrs):
Your gender:

MaleFemale
How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired?

This refers to your usual way of life recently.

Even if you haven’t done some of these things recently, try to figure out how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:

0 = no chance of dozing

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

It is important that you answer each item as best as you can.

Situation
Chance of dozing sitting and reading
Chance of dozing watching TV
Chance of dozing sitting inactive in a public place (e.g. , a theater or meeting)
Chance of dozing as a passenger in a car for an hour without a break
Chance of dozing lying down to rest in the afternoon when circumstances permit
Chance of dozing sitting and talking to someone
Chance of dozing sitting quietly after a lunch without alcohol
Chance of dozing in a car or bus, while stopped for a few minutes in traffic
Epworth Sleepiness Score
Interpretation of score:
0-5 Lower Normal Daytime Sleepiness
6-10 Higher Normal Daytime Sleepiness
11-12 Mild Excessive Daytime Sleepiness
13-15 Moderate Excessive Daytime Sleepiness
16-24 Severe Excessive Daytime Sleepiness

Copyright:
ESS © MW Johns 1990-1997
Reference(s):
Dr Johns’ personal website about the ESS. Available at:
http://epworthsleepinessscale.com/ . Accessed August 2017

Sample copy, do not use without permission. Epworth Sleepiness Scale contact information and permission to use: Mapi Research Trust, Lyon, France, https://eprovide.mapi-trust.org.
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Sleepiness Assessment

Epworth Sleepiness Scale