Sleep Quiz

Name
Date of Birth
Gender
Date Today

How likely are you to doze off or fall asleep in the situations described below, in contrast to feeling just tired?

Even if you have not done some of these things in the last month, try to imagine how they would have affected you.

Use the following scale to choose the most appropriate number for each situation:

0 - Would never done
1 - Slight chance of dozing
2 - Moderate chance of dozing
3 - High chance of dozing

***It is important that you answer each question as best as you can.***

Sitting and Reading
Watching TV
Sitting, inactive in a public place (eg. a theatre or a meeting)
As a passenger in a car for an hour without a break
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
Total out of 24:

Score Interpretation:
1-10 Normal Range
10-16 Excessively Sleepy
16-24 Abnormally Sleepy

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