Online Sleep Assesment

This simple self-test can help you measure your level of sleepiness. It also will help you talk with your doctor.

Your primary care doctor needs to know if you have trouble sleeping or experience excessive daytime sleepiness. If you need additional assessment, your doctor may refer you to Southwest Health Center’s Sleep Lab.

Directions:
Using a score of 0 to 3, rate the chances that you would doze off or fall asleep during these daily living activities. Place a number in each of the eight boxes to obtain an accurate score.

0 = Would never dose off
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Situation	Chance of dozing
Sitting and reading	0 1 2 3
Watching television	0 1 2 3
Sitting inactive in a public place (For example, a theater or meeting)	0 1 2 3
Being a passenger in a car for an hour without a break	0 1 2 3
Lying down to rest in the afternoon	0 1 2 3
Sitting and talking to someone	0 1 2 3
Sitting quietly after lunch (when you have had no alcohol)	0 1 2 3
In a car, stopped in traffic	0 1 2 3