ARFP

Autumn Road Family Practice

904 Autumn Road, #200

Little Rock, AR 72211

ARFP

Epworth Sleepiness Scale (ESS)

This questionaire will help you measure and report your general level of daytime sleepiness. You are to rate the chance that you would doze off or fall asleep durring different routine daytime situations.

How likely are you to fall asleep in the following situations, in contrast to just feeling tired? Even if you hanen't done some of these activities recently, think how they would have affected you.

1. Sitting and reading

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

2. Watching television

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

3. Sitting inactive in a public place - for example in a theater or a meeting

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

4. As a passenger in a car for an hour without a break

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

5. Lying down to rest in the afternoon

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

6. Sitting and talking to someone

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

7. Sitting quietly after lunch (when you've had no alcohol)

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

8. In a car, while stopped in trafic

Would never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing