Sleep Study Score Sheet How likely are you to doze off or fall asleep in the various situations described below in contrast to feeling just tired Even if you have not done some of these things recently try to work out
In the following situations what is your likelihood of falling asleep or dozing Answer using this scale What was your score 0 6 You are getting suficient sleep 7 9 An average score you are occasionally sleepy during the day 10 or higher You are not getting suficient sleep UNDERSTANDING YOUR SCORE 0 10 Normal range in healthy adults 11 14 Mild sleepiness 15 17 Moderate sleepiness 18 or higher Severe sleepiness If you scored 11 or higher consider seeing a sleep medicine specialist to diagnose and treat the cause of your sleepiness
Sleep Study Score Sheet
Sleep Study Score Sheet
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It has become one of the most frequently used methods for determining a person s average level of daytime sleepiness Please rate how likely you are to doze or fall asleep in the following situations by selecting the response that best applies How likely are you to doze off or fall asleep in the situations described below in contrast to feeling tired This refers to your usual way of life in recent times Even if you haven t done some of these things recently try to work out how they would have affected you Slight chance of dozing Moderate chance of dozing
Use the following scale to choose the most appropriate number for each situation It s important that you answer each question as best you can What does my score mean Talk to your GP about your circumstances Scores can be interpreted as follows Copyright N W Johns 1990 1997 Used under license Sample copy do not use without permission The following questionnaire will help you measure your general level of daytime sleepiness You are to rate the chance that you would doze off or fall asleep during different routine daytime
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Scoring Using a scale of 0 3 with 0 meaning would never doze and 3 meaning high chance of dozing respondents rate their likelihood of falling asleep in a variety of situations Total scores can range from 0 to 24 A score of 10 or higher is an indication of excessive sleepiness that should be evaluated 0 would never doze 1 slight chance of dozing 2 moderate chance of dozing
If your score is 10 or over then you may have a sleep disorder You should take this leaflet to your GP and ask whether or not you need a referral to a Sleep Clinic Use the following score to tick the most appropriate answer 1 Sitting and reading 2 Watching TV 3 Sitting inactive in a public place like a theatre or meeting 4 As a passenger in a car for an hour without a break 5 Lying down to rest in the afternoon when circumstances permit 6 Sitting and talking to someone 7
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How likely are you to doze off or fall asleep in the various situations described below in contrast to feeling just tired Even if you have not done some of these things recently try to work out
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In the following situations what is your likelihood of falling asleep or dozing Answer using this scale What was your score 0 6 You are getting suficient sleep 7 9 An average score you are occasionally sleepy during the day 10 or higher You are not getting suficient sleep
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Sleep Study Score Sheet - Use the following scale to choose the most appropriate number for each situation It s important that you answer each question as best you can What does my score mean Talk to your GP about your circumstances Scores can be interpreted as follows Copyright N W Johns 1990 1997 Used under license Sample copy do not use without permission
