EPWORTH SLEEPINESS SCALE FORM
Instructions: Be as truthful as possible. Print the form. Read the situation in the first column; select your
response from the second column; enter that number in the third column. Total all of the entries in the
third column and enter the total in the last box.
Situation
Sitting and Reading
Watching Television
Sitting inactive in a public place, for
example, a theater or a meeting
As a passenger in a car for an hour
without a break
Lying down to rest in the afternoon
Sitting and talking to someone
Sitting quietly after lunch when youve
had no alcohol
In a car while stopped in traffic
Responses
Score
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing
TOTAL SCORE
A score of 10 or greater indicates a possible sleep disorder. Take the completed form to your doctor.
Provided courtesy of Narcolepsy Network, Inc.
110 Ripple Lane
North Kingston, RI 02852
Toll free 888-292-6522
Tel 401-667-2523
Fax 401-633-6567
E-mail: narnet@narcolepsynetwork.org
Website: www.narcolepsynetwork.org
The Associated Professional Sleep Societies, Westchester, IL. Johns MW. A new
method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep
1991;14(6):540-545.
