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Reviews
SLEEP QUIZ
Name
*
First Name
Last Name
Email Address
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Phone
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(###)
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Message
*
Age
*
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently try to work out how they would have affected you.
It is important that you answer each question as best you can. 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
Describe your chance of dozing while:
Sitting and reading
0
1
2
3
Watching TV
0
1
2
3
Sitting inactive in a public place (theatre or a meeting)
0
1
2
3
As a passenger in a car for an hour without a break
0
1
2
3
Lying down to rest in the afternoon when circumstances permit
0
1
2
3
Sitting and talking to someone
0
1
2
3
Sitting quietly after lunch with no alcohol
0
1
2
3
While stopped for a few minutes in the traffic
0
1
2
3
Your total score
Thank you!
