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SLEEP SPECIALISTS

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Questionnaires
 
Fatique Severity Scale (FSS) I Epworth Sleepiness Scale (ESS)
 

The Fatique Severity Scale (FSS) is a method of evaluating the impact of fatique on you. The FSS is a short questionnaire that requires you to rate your level of fatique.

The FSS questionnaire contains nine statements that rate the severity of your symptoms. Read each statement and circle a number from 1 to 7, based on how accurately it reflects your condition during the past week and the extent to which you agree or disagree that the statement applies to you.

  • A low value (e,g., 1) indicates strong disagreement with the statement, whereas a high value (e.g., 7) indicates strong agreement.
  • It is important that you circle a number (1 to ) for every question.
Fatique Severity Scale (FFS) Questionnaire
During the Past Week I have found that I
  
Disagree <------------------> Agree
1.  
My motivation is lower when I am fatigued.
1
2
3
4
5
6
7
2.  
Exercise brings on my fatigue.
1
2
3
4
5
6
7
3.  
I am easily fatigued.
1
2
3
4
5
6
7
4.  
Fatique interferes with my physical functioning.
1
2
3
4
5
6
7
5.  
Fatique causes frequent problems for me.
1
2
3
4
5
6
7
6.  
My fatique prevents sustained physical functioning.
1
2
3
4
5
6
7
7.  
Fatique interferes with caring out certain duties and responsibilities
1
2
3
4
5
6
7
8.  
Fatique is among my three most disabling symptoms.
1
2
3
4
5
6
7
9.  
Fatique interferes with my work, family or social life.
1
2
3
4
5
6
7
     
© 2002 Cephalon
Your Total Score:
 _________

Scoring Your Results
Now that you have completed the questionnaire it is time to score your results and evaluate your level of fatique. It's simple: Add all the numbers you circled to obtain your total score.

The Fatique Severity Scale Key
A total score of 36 suggestions that you may be suffering from fatique, and may need further evaluation.

Epworth Sleepiness Scale (ESS)
 
The following questionnaire will help measure your general level of daytime sleepiness. You are to rate the chance that you would doze off or fall asleep during different routine daytime situations. Answers to the questions are rated on a reliable scale called Epworth Sleepiness Scale (ESS). Each item is rated from 0 to 3, with 0 meaning you would never doze or fall asleep in a given situation, and 3 meaning that there is a very high chance that you would doze or fall asleep in that situation.
 
Epworth Sleepiness Scale (ESS)
Situation
 
Chance of Dozing
1.
  
Sitting and reading.
0
1
2
3
2.
  
Watching television.
0
1
2
3
3.
  
Sitting inactive in a public place; a theater, church, meeting.
0
1
2
3
4.
  
As a passenger in a car for an hour without a break.
0
1
2
3
5.
  
Lying down to rest in the afternoon.
0
1
2
3
6.
  
Sitting and talking to someone.
0
1
2
3
7.
  
Sitting quietly after lunch (when you have had no alcohol).
0
1
2
3
8.
  
In a car while stopped in traffic
0
1
2
3
     
© 2002 Cephalon
Your Total Score:
 _________
     

Scoring Your Results
Now that you have completed the questionnaire, it is time to score your results. and evaluate your level of daytime sleepiness.

Epworth Sleepiness Scale Key
A total score of less than 10 suggests that you may not be suffering from excessive daytime sleepiness. A total score of 10 or more suggests that you may need further evaluation. It is important to remember that true exessive daytime sleepiness is almost always caused by an underlying medical conditiion that can be easily dianosed and effectivly treated.

 
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