Epworth Sleepiness Scale (ESS)

What is the Epworth sleepiness scale (ESS)?

The Epworth sleepiness scale (ESS) is a short self-assessment to identify how likely you are to fall asleep during the daytime.

There are eight questions on the assessment. They focus on common scenarios or activities that may make you sleepy to the point where you’ll fall asleep or doze off. Your answer for each scenario is a number on a four-point scale, from zero (would never doze off) to three (high risk of dozing off).

When is the Epworth sleepiness scale performed?

A healthcare provider may use the Epworth sleepiness scale to:

• Identify how daytime sleepiness affects you.
• Measure how the symptom (daytime sleepiness) changes before and after taking a medication or starting treatment.
• Determine if further testing is necessary to diagnose an underlying condition that affects your sleep, like sleep apnea or narcolepsy.

The Epworth sleepiness scale isn’t a diagnostic test for sleep disorders. Rather, it’s an assessment to learn more about the symptom of daytime sleepiness and if it interferes with your ability to do routine tasks. You’ll take this self-assessment as part of patient-entered data, usually before a sleep study.

How does the Epworth sleepiness scale work?

The Epworth sleepiness scale self-assessment takes only a few minutes to complete as part of patient-generated health data (patient-entered data) before an appointment.

First, you’ll read each question. Then, you’ll answer each question using the scale, from zero to three, provided. Answer each question to the best of your ability. The test doesn’t ask for any other details specific to your sleepiness other than a number from zero to three.

When you finish the self-assessment, a healthcare provider will add up the numbers to calculate your result. They’ll use your score to help make a diagnosis and determine if sleep testing is necessary.

What are the questions on the Epworth sleepiness scale?

There are eight questions on the Epworth sleepiness scale. You’ll rank the following on a scale of 0 (no risk of falling asleep) to 3 (high risk of falling asleep):

• Sitting down and reading.
• Watching TV.
• Sitting (inactive) in a public place (like a meeting or dinner event).
• Sitting in a car as the passenger for one consecutive hour without breaks.
• Lying down to rest during the daytime.
• Sitting and talking to another person.
• Sitting after eating a meal (alcohol not included).
• Driving a car while stopped in traffic for a few minutes.

What do the results of the Epworth sleepiness scale mean?

The Epworth sleepiness scale results range from 0 to 24. Results from 0 to 10 show average (normal) daytime sleepiness. A result under 10 may not be cause for concern or it could identify you have trouble sleeping (insomnia). A result from 11 to 24 indicates excessive (abnormal) daytime sleepiness. This could be a side effect of a medication or the result of an underlying health condition, for example.

The results are as follows:

• 0 to 5: Low daytime sleepiness (normal).
• 6 to 10: High daytime sleepiness (normal).
• 11 to 12: Mild excessive daytime sleepiness.
• 13 to 15: Moderate excessive daytime sleepiness.
• 16 to 24: Severe excessive daytime sleepiness.

If you score 11 or greater, you may need to change your sleeping habits at night. A healthcare provider may recommend additional testing to see if an underlying medical condition, psychiatric condition, substance or medication, or a primary sleep disorder is affecting your ability to stay awake.

When should I know the results of the test?

You’ll know the results of the Epworth sleepiness scale immediately after completing the self-assessment. A healthcare provider will add up your results and discuss what they mean and if you need additional testing.

If the results are abnormal, what are the next steps?

If your score is above 11 on the Epworth sleepiness scale, your healthcare provider may run further diagnostic tests to see what causes you to feel tired during the day. Excessive daytime sleepiness is a symptom rather than a medical condition. Testing determines what causes this symptom.

When should I call my healthcare provider?

If you feel daytime sleepiness and notice you’re unable to stay awake during routine activities, contact a healthcare provider for an evaluation.