This test is not intended as medical advice. If you think you may have a sleep disorder, contact your physician or Okanogan Douglas Hospital Sleep Medicine Center directly.
Choose only ONE (1) answer for each question below. Check the box next to each answer, then print this test and take it with you to discuss your sleep concerns with your physician. If you choose the wrong box for your answer, simply click on it again and the check mark will clear.
I. Daytime Sleepiness Test*
What is the chance that you will become sleepy or fall asleep while...
1. Sitting and reading?
No Chance
Slight Chance
Moderate Chance
High Chance
2. Riding as a passenger in an automobile?
No Chance
Slight Chance
Moderate Chance
High Chance
3. Lying down to rest during the day?
No Chance
Slight Chance
Moderate Chance
High Chance
4. Sitting and having a conversation with someone?
No Chance
Slight Chance
Moderate Chance
High Chance
5. Sitting after a lunch that did not involve alcoholic beverages?
No Chance
Slight Chance
Moderate Chance
High Chance
6. Sitting in a non-moving vehicle for any length of time?
No Chance
Slight Chance
Moderate Chance
High Chance
7. Watching television?
No Chance
Slight Chance
Moderate Chance
High Chance
SCORING FOR PART I:
Each "No Chance" = 0 points Each "Slight Chance" = 1 point Each "Moderate Chance" = 2 points Each "High Chance" = 3 points
Your Total Score = _____________
Normal = 12 points or less
II. Nightime Sleep Problems
1. Do you have trouble falling asleep or staying asleep?
Never
Occasionally
Often
Always
2. Do you feel poorly rested in the morning?
Never
Occasionally
Often
Always
3. Do sleep problems or daytime sleepiness interfere with your daily activities?
Never
Occasionally
Often
Always
4. Have you ever been told that you snore?
Never
Occasionally
Often
Always
5. Have you ever been told that you hold your breath while you sleep?
Never
Occasionally
Often
Always
6. Have you ever noticed your heart pounding or beating irregularly during the night?
Never
Occasionally
Often
Always
7. Have you ever awaken from sleep gasping for breath?
Never
Occasionally
Often
Always
8. Do you ever wake up with leg pain, leg cramps, leg numbness, or feeling like you need to move your legs often to feel comfortable?
Never
Occasionally
Often
Always
9. Approximately how many hours of sleep do you actually get each night, not counting time you may be lying there awake?
More than 10 hours
8 - 10 hours
6 - 7 hours
Less than 6 hours
10. Are you overweight?
30 or more lbs
20 - 29 lbs
10 - 19 lbs
1 - 9 lbs
Not overweight
SCORING FOR PART II:
Each "Never" = 0 points Each "Occasionally" = 1 point Each "Often" = 2 points Each "Always" = 3 points
For Question #9: "More than 10 hours" = 0 points "8 - 10 hours" = 1 point "6 - 7 hours" = 2 points "Less than 6 hours" = 3 points
For Question #10: "Not overweight" = 0 points "1 - 9 lbs" = 0 points "10 - 19 lbs" = 1 point "20 - 29 lb" = 2 points "30 lbs or more" = 3 points
Your Total Score = _____________
Normal = 16 points or less
Once again, this test is not intended as medical advice. If you think you may have a sleep disorder, contact your physician or ODH Sleep Medicine Center.
*Some questions in the first portion of this quiz are based on questions asked in the Epworth Sleepiness Scale (ESS) [Johns et al. Sleep 1991.14:540.]