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Rate Your Sleepiness
How likely are you to doze off or fall asleep in the following situations in contrast to just feeling tired?
0 = Would never doze.
1 = Slight chance of dozing.
2 = Moderate chance of dozing.
3 = High chance of dozing.
SITUATION
CHANCE OF DOZING
Sitting and Reading.
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Watching TV.
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Sitting inactive in a public place (i.e. theater).
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
As a passenger in car for an hour without a break.
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Lying down to rest in the afternoon.
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Sitting and talking.
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Sitting quietly after lunch.
--Select--
0 = Would never doze
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.
--Select--
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
Note: A score of 10 or greater suggests that you have a higher chance of sleep disorder.
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