Epworth Sleepiness Scale

Epworth Sleepiness Scale 2026-03-31T09:47:54-06:00

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Epworth Sleepiness Scale

Please complete the questions below. These questions are used to screen for possible obstructive sleep apnea and sleep-related breathing problems. Some items ask about your likelihood of dozing or falling asleep in certain situations, not just feeling tired. Please answer based on how you have felt recently.
Please enter your height.
Please enter your current weight.

Height and weight are collected to help estimate body mass index (BMI), which is a factor associated with obstructive sleep apnea risk.

Use the following to choose the most appropriate number for each situation.

Sitting and reading
Watching television
Sitting inactive in a public place ie: theatre or meeting
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon
Sitting and talking to someone
In a car, while stopped in traffic
Sitting quietly after lunch (when you’ve had no alcohol)
Have you been told that you grind your teeth during sleep?
When you wake up in the morning, which of the following do you experience?
(Check all that apply)

Nasal Obstruction Symptom Evaluation (NOSE)

Over the past 1 month how much of a problem were the following conditions for you?
Nasal blockage or obstruction
Nasal congestion or stuffiness
Trouble breathing through my nose
Unable to get enough air through my nose during exercise or exertion
Trouble sleeping

Visual Analog Scale

Mark on this line how troublesome it is breathing through your nose on average
Troublesome Breathing
None

Do you...

Snore loudly?
Often feel tired, fatigued or sleepy?
Been observed to stop breathing during sleep?
Beingtreated for or have high blood pressure?
MM slash DD slash YYYY
Name*
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    Due to increased patient care needs, Dr. Friesen is currently scheduling New Patient Jaw examinations in 24-36 months. Motor Vehicle examinations are scheduling in 8 weeks. All new patients can be added to Dr. Friesen's waitlist. For patients with urgent or acute care needs, please contact our office directly at 780.463.3616
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