Epworth Sleepiness Scale

In contrast to just feeling tired, how likely are you to doze-off or fall asleep in the following situations. Use the following scale to choose the most appropriate number for each situation.

0-Would never doze-off     1-Slight chance of dozing        2-Moderate chance of dozing               3-High chance of dozing.

                                                                                                                           Before Therapy                

Situation:                                                                                                   Score:                  

1) Sitting and reading                                                                              ____________                       

2) Watching television                                                                            ____________                      

3) Sitting inactive in a public place (i.e. theater)                                    ____________                        

4) As a car passenger for an hour without a break                                ____________                      

5) Lying  down to rest in the afternoon                                                ____________                     

6) Sitting quietly after lunch without alcohol                                       ____________   

7) Sitting and talking to someone                                                          ____________                      

8) Driving a car, stopped for a few minutes in traffic                          ____________  

 

                     

                                                                                              TOTAL:   ____________                      

A score of 6 or greater indicates the possibility of sleep disorder breathing.

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THORNTON SNORING SCALE

Snoring has a significant effect on the quality of life for many people. Snoring can affect the person snoring and those around him/her, both physically and emotionally. Use the following scale to choose the most appropriate number for each situation. (Go to question #4 if you do not have a bed partner.)

0-Never                                                                                                          2-Frequently (2-3 times per week)

1-Infrequently (1 night per week)                                                                 3- Most of the time 4 or more nights per week)

                                                                                                                                    Before Therapy  

 

Situation:                                                                                                       Score:

1) Snoring affects my relationship with my partner                                     __________                         

2) Snoring causes my partner to be irritable or tired                                    __________                          

3) Snoring requires us to sleep in separate rooms                                        __________                           

4) I have a morning headache                                                                       __________                             

5) I lose my concentration and /or fall asleep inappropriately                    __________                            

6) My sleep does not seem to be restorative or restful                               __________                             

7) I feel depressed or "down"                                                                      __________                          

8) My snoring is loud                                                                                  __________                            

9) My snoring affects people when I am sleeping away from home          __________  

 

                       

                                                                                            TOTAL:         __________                            

                                                                                      A score of 8 or greater indicates your snoring may be significantly affecting your quality of life.