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EPWORTH SLEEPINESS SCALE QUESTIONNAIRE

Home » EPWORTH SLEEPINESS SCALE QUESTIONNAIRE

Patient Name *

Physician Name *

Sitting and reading

00
01
02
03

Watching TV

00
01
02
03

Sitting and talking with someone

00
01
02
03

Sitting, inactive in a public place (for example, a theater or a meeting)

00
01
02
03

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

00
01
02
03

Lying down to rest in the afternoon when circumstances permit

00
01
02
03

Sitting quietly after a lunch without alcohol

00
01
02
03

In a car, while stopped for a few minutes in traffic

00
01
02
03

Your usual body position during sleep

Supine
Lateral
Prone
Upright

Email *

Email

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1-800-419-0210
information@apneasimplified.com

Follow Us :

Home
About Sleep Apnea
- Our Doctor
For Physicians
- Apnea Test Order Form
Order Sleep Test
For Patients
Contact Us