This scale is used as a screening tool only and is not meant in any way to diagnose a particular sleep disorder. Only a physician can accurately make that diagnosis.

Use the following scale to choose the most appropriate number for each situation:
0 = would never doze
1 = slight chance of dozing
2 = moderate chance of dozing
3 = high chance of dozing

	Situation	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 lunch without alcohol	______________
	In a car, while stopped for a few minutes in traffic	______________
	TOTAL	______________

Scoring:

0 - 6	Normal, no action necessary
7 - 24	Sleepy, seek medical advice

For more information about sleep disorders, contact your primary care physician or the Deaconess Sleep Center at 812/450-3852 or by e-mail

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