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sleep test


Sleep Test

In contrast to just feeling tired, how likely are you to doze off or fall asleep in the following situations? Use the following scale to choose the most appropriate number for each situation.

Please feel free to print this test, fill it out and take with you to your physician.

0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing                     
3 = High chance of dozing

0 1 2 3

Sitting and reading.

Watching television.

Sitting inactive in a public place (i.e. theater)

As a car passenger for an hour without a break.

Lying down to rest in the afternoon.

Sitting and talking to someone.

Sitting quietly after lunch without alcohol.

In a car, while stopping for a few minutes in traffic

    Your Score

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A score of 6 or greater indicates the possibility of a sleep breathing disorder.