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Barnesville, OH 43713  
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The Epworth Sleepiness Scale

Please fill out these fields, then click submit to display a printable information sheet to give to your doctor.

Name:
Date:
Age:
Sex:

Please rate your chance of dozing off/falling asleep for each of the following situations, based on a scale of 0-3:
Sitting and reading
Watching television
Sitting inactive in a public place (e.g., theater or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after lunch with alcohol
In a car, while stopped for a few minutes in traffic