Get the free The Epworth Sleepiness Scale - Dreamhaven Dental Sleep Medicine

*Tired all the time? You may have Oral Sleep Apnea. Answer this questionnaire and give it to any team member. The Epworth Sleepiness Scale Name: Today's Date: Your Age (years): Your Sex: Male Female

How to fill out form epworth sleepiness scale

How to fill out form epworth sleepiness scale

1. To fill out the Epworth Sleepiness Scale form, follow these steps:
2. Rate your chances of dozing off or falling asleep in the following situations on a scale of 0 to 3, where 0 represents no chance of dozing and 3 represents a high chance of dozing:
3. - Sitting and reading
4. - Watching TV
5. - Sitting inactive in a public place (e.g., a theater, a meeting)
6. - As a passenger in a car for an hour without a break
7. - Lying down to rest in the afternoon when circumstances permit
8. - Sitting and talking to someone
9. - Sitting quietly after a lunch without alcohol
10. - In a car while stopped for a few minutes in traffic
11. Add up the scores for each situation to get your total score.
12. Interpret your score based on the following scale:
13. - 0 to 5: Considered to be within the normal range
14. - 6 to 10: Average daytime sleepiness
15. - 11 to 12: Mild excessive daytime sleepiness
16. - 13 to 15: Moderate excessive daytime sleepiness
17. - 16 to 24: Severe excessive daytime sleepiness

Who needs form epworth sleepiness scale?

1. The Epworth Sleepiness Scale form is needed by individuals who suspect they may be experiencing excessive daytime sleepiness or have sleep disorders. It is also used by healthcare professionals, such as sleep specialists or doctors, to assess an individual's daytime sleepiness level and aid in diagnosing sleep disorders.

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What is form Epworth Sleepiness Scale?

The Epworth Sleepiness Scale is a questionnaire used to assess daytime sleepiness. It asks individuals to rate their likelihood of falling asleep in eight different daily life situations.

Who is required to file form Epworth Sleepiness Scale?

The form is typically filled out by individuals who suspect they may have a sleep disorder or excessive daytime sleepiness.

How to fill out form Epworth Sleepiness Scale?

To fill out the form, individuals should rate the likelihood of falling asleep in each of the eight situations on a scale from 0 to 3, with 0 indicating no chance of falling asleep and 3 indicating a high chance of falling asleep.

What is the purpose of form Epworth Sleepiness Scale?

The purpose of the Epworth Sleepiness Scale is to help healthcare professionals assess a patient's level of daytime sleepiness and determine if further evaluation for a sleep disorder is necessary.

What information must be reported on form Epworth Sleepiness Scale?

The form requires individuals to provide their ratings for each of the eight scenarios and may also ask for additional information such as age, gender, and medical history.