This questionnaire was developed to determine the level of daytime sleepiness in individuals. 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. If you have not done some of these activities recently, select what would most likely happen if you were in that situation.
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
It is important that you answer each question as best you can.
Please add together the total number from your responses above and enter total here.
Your information will be encrypted.
Center for TMJ & Sleep Solutions NW
BOARD CERTIFIED OROFACIAL PAIN AND DENTAL SLEEP MEDICINE DOCTORS
Silverdale: 360-979-1537, Federal Way: 253-352-4430, Lynnwood: 425-584-5924