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Use the following scale to choose the most appropriate number for each situation:

0 = would never doze or sleep
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping

Situation	Chance of Dozing or Sleeping
Sitting and reading	_____________
Watching TV	_____________
Sitting inactive in a public place	_____________
Being a passenger in a motor vehicle for an hour or more	_____________
Lying down in the afternoon	_____________
Sitting and talking to someone	_____________
Sitting quietly after lunch (no alcohol)	_____________
Stopped for a few minutes in traffic while driving	_____________
Total score (add up the score) (This is your Epworth score)	_____________

If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene and/or need to see a sleep specialist. These issues should be discussed with your personal physician.