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 have not done some of these things recently, try to work out how they would affect you.
Using the following scale, check the most appropriate number for each situation:

0 = would never doze or fall asleep
1 = slight chance of dozing or falling asleep
2 = moderate chance of dozing or falling asleep
3 = high chance of dozing or falling asleep

Situation Chance of Dozing

0 1 2 3

Sitting & Reading

Watching TV

Sitting, inactive in a public place (e.g. theater, meeting, park)

As a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking to someone

Sitting quietly after a lunch without alcohol

In a car, while stopped for a few minutes in traffic

Do I have a Sleep Disorder?

Situation	Chance of Dozing
Situation	0	1	2	3
Sitting & Reading
Watching TV
Sitting, inactive in a public place (e.g. theater, meeting, park)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in traffic

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 have not done some of these things recently, try to work out how they would affect you.Using the following scale, check the most appropriate number for each situation:

This refers to your usual way of life in recent times.
Even if you have not done some of these things recently, try to work out how they would affect you.
Using the following scale, check the most appropriate number for each situation: