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CookStPharmacy | Sleep Apnoea Survey
Sleep Apnoea is a problem that usually goes undetected. Here's a quick screening survey.
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Name
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Epworth Sleepiness Scale
Please answer these questions below.
How likely are you to doze off or fall asleep when you are sitting and reading
Highly Likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep when you are watching TV
Highly likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep when you are sitting in active in a public place like a meeting, church service, or theatre?
Highly likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep when you are a passenger in a car for an hour without a break
Highly likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep if you are lying down in the afternoon
Highly likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep when you are sitting talking to someone
Highly likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep when you are in a vehicle, while stopped for a few minutes in traffic
Highly likely
Moderately likely
Slightly likely
Never
Select One
How likely are you to doze off or fall asleep when you are sitting quietly after lunch without alcohol
Highly likely
Moderately likely
Slightly likely
Never
Select One
Your Epworth Score:
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