Tri-Hospital Sleep Laboratory West

The Cooksville Colonnade Building 3024 Hurontario Street, Suite 208 Mississauga, ON, L5B 4M4 Canada	Office Tel: Office Fax: Sleep Lab:	905.566-1010 905-566-0440 905-566-9666
E-mail: md@sleeplab.ca

Sleep disorders, sleep apnea, sleep test

Quick Assessment of Insomnia Severity:
Evaluation of Daytime Drowsiness

Chance of Dozing:
0 = would never doze 1 = slight chance of dozing	2 = moderate chance of dozing 3 = high chance of dozing

	0	1	2	3
Sitting and reading
Watching TV
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

Total score:

Score interpretation

1-6: Getting enough sleep
4-8: Tends to be sleepy but is average
9+: Very sleepy and suggestive of sleep-disorder breathing. Patient should seek medical advice.

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