Sleep Questionnaire
How likely is it that you will fall asleep in the following conditions?
|
0=would never doze 1=slight chance of dozing |
2=moderate chance 3=high chance |
| Sitting and reading |
0 | 1 | 2 | 3 |
| Watching TV |
0 | 1 | 2 | 3 |
| Sitting in a public place |
0 | 1 | 2 | 3 |
| Riding in a car for 1 hour | 0 | 1 | 2 | 3 |
| Lying down to rest in the afternoon | 0 | 1 | 2 | 3 |
| Sitting and talking | 0 | 1 | 2 |
3 |
| Sitting after lunch without alcohol | 0 | 1 | 2 | 3 |
| Behind the wheel of a car while stopped in traffic | 0 | 1 | 2 | 3 |
If your total score is 10 or more, see your doctor. A score of 10 or more is enough to qualify you for a sleep study.
