Rate the Possibility of Falling Asleep When Doing The Following Tasks On A Scale of 1-3:

0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

Sitting and reading ________________________________________ 

Watching TV ________________________________________ 

Sitting, inactive in a public place (e.g. 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 the traffic ________________________________________________________ 

If you add up your score and it is greater than 10, that indicates that you may be at risk for a sleep disorder. Please contact us if you have any questions about your score or the possibility that you may be excessively sleepy!