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What is Epworth Sleepiness Scale Scoring?

Medically Reviewed by Dan Brennan, MD on June 21, 2021

The Epworth Sleepiness Scale (ESS) is a questionnaire to check a person’s sleepiness during the day. You can take the test yourself, but the results are more accurate when it's given by a doctor.

Commonly used in the field of sleep medicine, the test gives eight situations in which the respondent rates their tendency to become sleepy on a scale of 0 to 3. The final score estimates whether or not the respondent might be experiencing excessive or abnormal sleepiness — which could be a sign of an underlying condition or require medical attention. 

Background of the Epworth Sleepiness Scale

The Epworth Sleepiness Scale was first developed in 1990 by Australian doctor Murray Johns. It was created as a means of checking the “daytime sleepiness” of patients at his private sleep medicine practice. 

Daytime sleepiness may be a sign of an underlying medical condition, including sleep disorders like narcolepsy. Narcolepsy is a chronic sleep disorder where you are extremely drowsy and randomly fall asleep. Although it’s not designed to be a diagnostic tool, it can help doctors see if you potentially have a sleep disorder.

The self-reported questionnaire has eight questions. Respondents rate their chances of dozing off or falling asleep during various activities. It takes approximately 2 to 3 minutes to answer. While it was first created for adults, a modified version known as the ESS-CHAD was created for children and adolescents. The structure remains the same, but the instructions and activities have been changed to better relate to children. 

Where to Find the Questionnaire

Each one of the eight questions on the ESS presents an activity you might do during the day. For each question, you’re asked to rate it from 0 to 3, with 0 meaning you have no chance of dozing off and 3 meaning you have a moderate chance of dozing. 

The questionnaire asks: “How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?” Even if you haven’t done any of these activities recently, the ESS asks you to estimate how they would likely affect you.

The situations presented include: 

  • Sitting and reading
  • Watching TV
  • Sitting, inactive in a public place (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 the traffic

Each activity varies in its somnificity, which is the posture, activity, and situation in which sleep is measured. This allows the questionnaire to find out how different postures or activities might impact how likely you are to fall asleep.

You can find the questionnaire through the Centers for Disease Control and Prevention (CDC) or the American Sleep Apnea Association. 

Understanding Your Results

At the end of the questionnaire, you can add up the numbers to find your final result. The higher your score, the higher your daytime sleepiness is. 

A "normal" ESS score is considered between 0 and 10. 

Those with scores of 11 to 24, however, are considered to have excessive daytime sleepiness. In one study that looked at the range of excessive daytime sleepiness, participants with narcolepsy or idiopathic hypersomnia scored between the range of 12 to 24.

Idiopathic hypersomnia is a sleep disorder where even after sleeping well the night before or sleeping for a long period of time, you are very tired during the day.

What Your ESS Score Could Mean

The ESS is not a diagnostic test. As it’s self-reported, the ESS is meant to show whether or not you may have excessive daytime sleepiness, which could be a sign of an underlying medical disorder. If you score higher than 10 on the questionnaire, your doctor may recommend you see a sleep specialist. 

Several sleep conditions can cause excessive daytime sleepiness.

  • Hypersomnia 
  • Sleep apnea, when your breathing stops and starts while you are asleep {Mayo Clinic: "Sleep apnea."}
  • Narcolepsy

Other factors may also be at the root of your excessive daytime sleepiness, including: 

  • Stroke
  • Cancer
  • Inflammatory conditions
  • Depression 
  • Use of sedative medications (antihistamines, antidepressants, etc.) 
  • Drug and alcohol use

Reliability of the ESS

There is strong evidence to support the ESS as a valid and reliable means of testing daytime sleepiness. 

One study found that ESS was able to identify narcoleptic patients from those with normal sleep patterns. Another study found that those with higher ESS scores had lower connectivity between the thalamus and the regions of the brain involved in regulating motor functions when you are in the resting awake state. 

While the ESS has been proven to be an effective screening tool, it is not a diagnostic tool by itself and it can’t tell whether or not you have a sleep disorder. 

The questionnaire can also be self-taken, but this may make the results less accurate. A 2013 study found that people with obstructive sleep apnea had more accurate ESS results when the test was given by a physician rather than when it was done by themselves. 

Seeking Treatment

While the ESS can’t diagnose a sleep disorder or another underlying condition, it can be used as a screening tool to help your doctor find out whether or not you need further treatment. If you self-took the questionnaire and received a score of 11 or higher, further testing with a medical professional can help find out the cause. 

Other factors could influence results, however. Sleep deprivation, physical fatigue, or occasional insomnia could drive up your score. 

Regardless of your score on the ESS, if you’re having issues with the quality of your sleep or your level of sleepiness during the day, reach out to your doctor. 

Show Sources

SOURCES: 

American Family Physician: "Excessive Daytime Sleepiness."

American Sleep Apnea Association: "Epworth Sleepiness Scale."

Centers for Disease Control and Prevention (CDC): "Epworth Sleepiness Scale"

Chest: "The Epworth Sleepiness Scale: Conventional Self vs Physician Administration."

The Epworth Sleepiness Scale: "About the ESS," "About the ESS-CHAD."

Journal of Sleep Research: "The Clinical Diagnosis of the Narcoleptic Syndrome."

Mayo Clinic: "Idiopathic hypersomnia," "Narcolepsy," "Sleep apnea."

Neuroreport: "Daytime Sleepiness is Associated With Altered Resting Thalamocortical Connectivity."

Sleep: "Daytime Sleepiness and Sleep Habits of Australian Workers."

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