REM Sleep Labs

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Patient Forms

The Epworth Sleepiness Scale is a common tool used by physicians to determine the likelihood that you may have a sleeping disorder.

After answering the questions below, a score will be generated to help evaluate if you are at possible risk of having a sleep disorder.

You may contact our office or consult with your physician to see if a sleep study can be of benefit to you.

0 = No chance of dozing.
1 = Slight chance of dozing.
2 = Moderate chance of dozing.
3 = High chance of dozing.

Sitting and reading
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
Watching TV
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
Sitting inactive in a public place (e.g a theater or a meeting)
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
As a passenger in a car for an hour without a break
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
Lying down to rest in the afternoon when circumstances permit
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
Sitting and talking to someone
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
Sitting quietly after a lunch without alcohol
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.
In a car, while stopped for a few minutes in traffic
0 - No chance of dozing.
1 - Slight chance of dozing.
2 - Moderate chance of dozing.
3 - High chance of dozing.

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