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Epworth Sleepiness Scale PDF
Electronic Epworth Sleepiness Scale (ESS) 2017
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D O B
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Day
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The following questionnaire will help you measure your general level of daytime sleepiness. You are to rate the chance that you would doze off or fall asleep during different routine daytime situations. Answers to the questions are rated on a reliable scale called the Epworth Sleepiness Scale (ESS). Each item is rated from 0 to 3, with 0 meaning you would never doze or fall asleep in a given situation, and 3 meaning there is a very high chance that you would doze or fall asleep in that situation.
How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? Even if you haven’t done some of the activities recently, think about how they would have affected you.
Use this scale to choose 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
It is important that you select a number (0 to 3) for EACH situation.
SITUATION
Sitting and reading
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0
1
2
3
Watching television
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0
1
2
3
Sitting inactive in a public place (theater/meeting)
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0
1
2
3
As a passenger in a car for an hour without a break
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0
1
2
3
Lying down to rest in the afternoon
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0
1
2
3
Sitting and talking to someone
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0
1
2
3
Sitting quietly after lunch (with no alcohol)
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0
1
2
3
In a car, while stopped in traffic
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0
1
2
3
0–9 range is considered to be normal.
11–15 are shown to indicate the possibility of mild to moderate sleep apnea.
16 and above indicates the possibility of severe sleep apnea or narcolepsy.
10–24 range indicates that expert medical advice should be sought
Sleep Study at the comfort of your home using SOMNOscreen™ plus, the smallest state of the art wireless PSG system with up to 28 channels or ApneaLink Plus, that will allow you to move freely anywhere in your home without any tech assistance. Tel: (305) 606-5332 • e-mail:
info@conciergesleepmedicine.com
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