SLEEP TEST (Epworth scale)



I) How would you rate the quality of your sleep last month?
Very good
Acceptable
Bad
Very bad
II) Last month, how many minutes did you take on average to fall asleep in the evening?
0-20 min.
21-30 min.
31-60 min.
more than 60 min.
III) Last month, how often did you wake up per night?
Never
1-3 times
4-5 times
more than 5 times
IV) Last month, how many hours did you sleep per night? Subtract the time you have been awake.
8 hours
6-7 hours
5-6 hours
less than 5 hours
V) Last month, how often did you feel sleepy during the day?
Never
Sometimes
Often
Always
VI) Last month, how often have you used natural products (tea, homeopathic remedies, herbal extracts as drops or pills) to fall asleep?
Never
1-7 times
8-20 times
More than 20 times
VII) Last month, how often have you used prescription medicines to be able to fall asleep?
Never
1-7 times
8-20 times
More than 20 times
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