0 = Never
1 = Infrequently (1 night per week)
2 = Frequently (2-3 nights per week)
3 = Most of the time (4 or more nights per week)
| SITUATION | CHANCE OF DOZING |
| Loud, irritating snoring | |
| Choking or gasping for air | |
| Pauses in breathing | |
| Twitching / kicking of arms or legs | |
| Snoring requiring separate bedrooms | |
| Falling asleep inappropriately (example: while driving or at meetings) | |
| TOTAL SCORE = |
