A Very Simple Sleep Questionnaire


The form below is worth taking the time to fill out. It’s quite short and straight forward and may lead you in a positive direction towards your overall improved physical and mental health.

Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? This refers to daily life in recent times; if these things have not occurred recently, try to work out how they would have affected you. Use the following scale and choose the most appropriate number for each situation:

0=would never doze

1=slight chance of dozing

2=moderate chance of dozing

3=high chance of dozing

Situation:                                                                                                Chance of Dozing 0-3:
Sitting and reading—–
Watching TV—–
Sitting inactive in a public place (e.g. A theater or Meeting)—–
As a passenger in a car for an hour without a breath—–
Lying down to rest in the afternoon when circumstances permit—–
Sitting and talking to someone—–
Sitting quietly after a lunch without alcohol—–
In a car, while stopped for a few minutes in traffic—–

A score of greater than 10 is consistent with excessive daytime sleepiness and a score of greater than 16 is indicative of a high level of daytime sleepiness.

If you took the time to fill out this form, then you may be on the road towards better health.

However, we’re not finished…we need to ask a small favour of your bed-partner: Please stay tuned for the next blog…

Until then,

Yours in health & wellness,

Dr. F. Keshavarz Dentistry

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