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.

Situation                                                                                                                    Chance of Dozing

                                                                                                                Before Therapy                  After Therapy

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) Living 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.

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)

Situation                                                                                                        Before Therapy                   After Therapy

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.