Sleepiness Self Test

The only way to be sure if you have obstructive sleep apnea is to have a sleep test from a qualified sleep technician. A score of 9 or above on this test is an indication that you should see your doctor.

Please feel free to print this test, fill it out and bring it with you for a complimentary consultation with Dr. Provencher, who will then discuss your options.

THE EPWORTH SLEEPINESS SCALE

How likely are you to doze off or fall asleep in the following situations? Choose the most appropriate number for each situation:

0 – would never doze
1 – slight chance of dozing
2 – moderate chance of dozing
3 – high chance of dozing

ACTIVITY Score

Sitting and reading _____
Watching TV _____
Sitting, inactive in a public place (theatre, meeting) _____
As a passenger in a car for an hour without a break _____
Lying down to rest in the afternoon when possible _____
Sitting and talking to someone _____
Sitting quietly after lunch without alcohol _____
In a car, while stopped for a few minutes in traffic _____
TOTAL __________

A score of 9 or above indicates you may be having a problem with daytime sleepiness but below 9 does not necessarily mean that you don’t have a problem. Book for a complimentary consultation for professional advice if you snore, have been told that you wake gasping for breath or if you are sleepy during the day.