Epworth Sleepiness Scale
Use this scale to determine your patient’s level of sleepiness.

Choose the most appropriate number for each situation:
0 = no chance of dozing
1 = slight chance of dozing or sleeping
2 = moderate chance of dozing or sleeping
3 = high chance of dozing or sleeping
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Rested Care Management
During these situations, what is the chance of dozing/sleeping? *
Please select all that apply
0 = No chance of dozing
1 = Slight chance of dozing/sleeping
2 = Moderate chance of dozing/sleeping
3 = High chance of dozing/sleeping
While Reading
Watching TV
Sitting inactive in a public place
In a car, while stopped for a few mins in traffic
As a passenger in a car for an hour without a break
Sitting and talking to someone
Sitting quietly after lunch without alcohol
Lying down to rest in the afternoon when time permits
Any additional questions or concerns? *
A copy of your responses will be emailed to the address you provided.
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