Sleep Quiz

Use the following scale to assign the most appropriate number for each situation listed. A score of 10+ could indicate you should have a sleep study to address your healthcare needs.

0 = No chance of dozing
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing

Sitting and reading
Watching television
Sitting inactive in a public place (e.g. theater or meeting)
As a passenger in a car for an hour without a break
Lying down for a rest in the afternoon (if time allows)
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic
First Name
Phone Number
Preferred method of contact? (Email or Phone)

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