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Watermark Medical EPWORTH sleepiness scale Questionnaire

  • PRINT IN CAPITAL LETTERS-STAY WITHIN THE BOX

  • Pounds
  • Years
  • Feet
  • Inches
  • Inches
  • COMPLETELY FILL IN ONE CIRCLE FOR EACH QUESTION- ANSWER ALL QUESTIONS

  • Epworth Sleepiness Scale: 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 in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to mark the most appropriate box for each situation. (M.W. Johns, Sleep 1991)

    0 = would never doze
    1 = slight chance of dozing
    2 = moderate change of dozing
    3 = high chance of dozing

    • Epworth Score
      TOTAL the
      values from all
      8 questions,
      If 11 or less
      Score = 0
      If 12 or more
      Score = 2
    • Score

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