Tue, September 07, 2010    





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Hospice Home Care Personal Care Medical Supplies/Equipment Physician Connection Careers McLaren Subsidiaries






Sleep Evaluation
How likely are you to doze off or fall asleep in the situations described below, 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.

After your results are evaluated, if you would like someone to contact you with more information, please include your name and phone or email address.

Name: 
Your age: (Yr) 
Your sex: 

E-mail Address 

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 

Sitting and reading 
Watching TV 
Sitting, inactive in a public place (e.g. a theatre or a meeting) 
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 
Your Total Score 

Score:
0 - 10 Normal Range
10 - 12 Borderline
12 - 24 Abnormal 

 


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