Sleep Assessment Epworth Sleepiness Scale InstagramThis field is for validation purposes and should be left unchanged.Complete the following survey for an evaluation of the likelihood you have issues with sleep apnea. Even if you haven't done some of these things recently, try to work out how they would have affected you. It's important that you answer each question as best you can. How likely are you to doze off or fall asleep in the following situation, in comparison to feeling just tired? This refers to your usual way of life in recent times.Sitting and reading 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.Watching TV 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.Sitting still in a public place (for example, a theater, the cinema, a meeting) 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.As a passenger in a car for an hour without a break 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.Lying down to rest in the afternoon when the circumstances allow 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.Sitting and talking to someone 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.Sitting quietly after lunch without having drunk alcohol 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.In a car or bus while stopped for a few minutes in traffic 0 (would not doze) 1 (slight chance of dozing) 2 (moderate chance of dozing) 3 (high chance of falling asleep) Enter your answer(Required)Please enter a number from 0 to 3.This field is hidden when viewing the formYour ScoreName(Required) First Last Email(Required) Phone(Required)May we contact you via phone or email to discuss your results and ask if you’d like to schedule a free consultation?(Required) Yes No
