The Epworth Sleepiness Scale (ESS) is a subjective patient questionnaire that evaluates the extent of daytime sleepiness in everyday situations. If you want to find out whether your daytime drowsiness is serious enough to warrant a call to your doctor, take this questionnaire to see where you rank on the Epworth Sleepiness Scale.
This questionnaire asks you to rate your likelihood of falling asleep in certain situations you encounter in the course of your day. On the form below, choose the option that best reflects your recent experience. If you haven't engaged in some of these activities, try to imagine how they would affect you. Answers are rated from a low of zero to a high of three. An answer of zero means you would never fall asleep in this situation, while answering three means it's very likely that you would.
After completing this questionnaire below click the results button which will tally your results. A score of 10 or more suggests that you might be suffering from excessive daytime sleepiness. You can then print the completed form and take the results to discuss with your doctor.
References:

1. XYREM® is a controlled substance. Controlled substances are medicines that, if abused, may lead to varying degrees of physical or psychological dependence. XYREM is a Schedule III drug — which means that it has a moderate dependence liability. If you sell, distribute, or give your XYREM to anyone else or use it for purposes other than what it was prescribed for, you may be punished under federal and state law by jail and fines.
2. It is very important to keep XYREM out of reach of children and pets.
3. XYREM can cause serious side effects including trouble breathing while asleep, confusion, abnormal thinking, depression and loss of consciousness. Tell your doctor if you have any of these problems while taking XYREM.
Central Nervous System Depressant with Abuse Potential. Should not be used with alcohol or other CNS depressants. Sodium oxybate is a form of GHB, a known drug of abuse. Abuse has been associated with some important central nervous system (CNS) adverse events (including death). Even at recommended doses, use has been associated with confusion, depression, and other neuropsychiatric events. Reports of respiratory depression occurred in clinical trials. Almost all of the patients who received sodium oxybate during clinical trials were receiving CNS stimulants.
Important CNS adverse events associated with abuse of GHB include seizure, respiratory depression and profound decreases in level of consciousness, with instances of coma and death. For events that occurred outside of clinical trials, in people taking GHB for recreational purposes, the circumstances surrounding the events are often unclear (e.g., dose of GHB taken, the nature and amount of alcohol or any concomitant drugs).
XYREM is available through the XYREM Success Program®, using a centralized pharmacy 1-866-XYREM88® (1-866-997-3688). The Success Program provides educational materials to the prescriber and the patient explaining the risks and proper use of sodium oxybate, and the required prescription form. Once it is documented that the patient has read and/or understood the materials, the drug will be shipped to the patient. The XYREM Success Program also recommends patient follow-up every 3 months. Physicians are expected to report all serious adverse events to the manufacturer.