Sleep Assessment

Please consider how likely you are to doze off or fall asleep in the following situations, rather than just feeling tired. Think about your usual daily life over recent times. Even if you haven’t experienced some of these situations recently, try to estimate how they would likely affect you.

*Mobile users may need to rotate device to complete the form.

Use the following scale to respond to each situation:

0 = would never doze

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

Complete the form below to provide your responses.

*Mobile users may need to rotate device to complete the form.

Use the following scale to respond to each situation:

0 = would never doze

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing

Complete the form below to provide your responses.

Sitting and reading0123

Watching TV0123

Sitting inactive in a public place (theatre or a meeting)0123

As a passenger in a car for an hour without a break0123

Lying down to rest in the afternoon when circumstances permit0123

Sitting and talking to someone0123

Sitting quietly after lunch with no alcohol0123

While stopped for a few minutes in the traffic0123

Sitting and reading0123

Watching TV0123

Sitting inactive in a public place (theatre or a meeting)0123

As a passenger in a car for an hour without a break0123

Lying down to rest in the afternoon when circumstances permit0123

Sitting and talking to someone0123

Sitting quietly after lunch with no alcohol0123

While stopped for a few minutes in the traffic0123

Our team will review your responses and reach out to you soon to discuss your score. They will help determine whether a sleep study may be beneficial for you and guide you through the next steps toward better sleep health.

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Having Trouble Sleeping?

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Having Trouble Sleeping?

Take Our Sleep Quiz

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(405) 753-6142

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3418 NW 135th St

Oklahoma City, OK 73120