If you constantly feel tired during the day, it could be more than just a lack of sleep—it may indicate an underlying problem such as sleep apnoea or narcolepsy. Did you know you can perform an evaluation yourself? Enter the Epworth Sleepiness Scale (ESS). It’s a widely used self-assessment tool that provides valuable insight into sleep patterns and potential sleep disorders, helping physicians determine whether further testing is needed to address fatigue’s root cause(s).
What Is the Epworth Sleepiness Scale (ESS) and How Does it Work?
The Epworth Sleepiness Scale is a quick self-assessment that takes only a few minutes to complete.
It is usually administered before an appointment with a healthcare provider or before undergoing a sleep study.
Steps to complete the ESS assessment:
- Read each question carefully.
- Rate your likelihood of dozing off using the four-point scale.
- Provide the most accurate responses based on your recent experiences.
- A healthcare provider calculates the total score and interprets the results.
This assessment does not ask for additional details about sleep habits but focuses specifically on daytime drowsiness.
Developed by Dr. Murray Johns in 1991, the Epworth Sleepiness Scale is a short, structured questionnaire that helps gauge the likelihood of falling asleep in daily situations. This test consists of eight questions, each describing a routine activity. You will be asked to rate how likely you are to doze off in each scenario using a four-point scale:
- 0: Would never doze off
- 1: Slight chance of dozing off
- 2: Moderate chance of dozing off
- 3: High chance of dozing off
The final score ranges from 0 to 24 and helps determine the severity of daytime sleepiness. This self-assessment serves as a screening tool rather than a diagnostic test, allowing healthcare providers to evaluate whether further investigation is required.
When Is the Epworth Sleepiness Scale Used?
Physicians use the Epworth Sleepiness Scale in various situations, such as:
- Assessing how daytime sleepiness affects daily activities.
- Monitoring changes in sleepiness before and after treatment.
- Determining whether additional sleep studies are necessary for diagnosing conditions like sleep apnoea, narcolepsy, or other sleep disorders.
When Will You Know Your Results?
One key benefit of the Epworth Sleepiness Scale is that results are available immediately after completing the questionnaire. A healthcare provider will review your total score and discuss whether additional testing is required.
This simple eight-question assessment, explained below, helps identify potential sleep disorders affecting daily life.
Questions on the Epworth Sleepiness Scale
The ESS includes eight questions describing a situation where you might feel sleepy. You will rate your likelihood of dozing off on a scale of 0 (no risk) to 3 (high risk). The scenarios include:
- Sitting and reading
- Watching TV
- Sitting inactive in a public place (e.g., in a meeting or at a social event)
- Being a passenger in a car for an hour without a break
- Lying down to rest during the day
- Sitting and talking to someone
- Sitting quietly after lunch (without alcohol consumption)
- Driving a car, while stopped in traffic for a few minutes
After completing the assessment, the total score determines the level of daytime sleepiness and whether further testing is necessary.
After taking the test, the next step is understanding the results. Here’s a breakdown to help you interpret the results.
Understanding Epworth Sleepiness Scale Results
The ESS score ranges from 0 to 24, with higher scores indicating greater levels of daytime sleepiness. The results are classified as follows:
- 0 to 5: Low daytime sleepiness (normal)
- 6 to 10: High daytime sleepiness (normal)
- 11 to 12: Mild to moderate excessive daytime sleepiness
- 13 to 15: Moderate to severe excessive daytime sleepiness
- 16 to 24: Severe excessive daytime sleepiness
A score of 11 or higher suggests excessive daytime sleepiness, which may require further medical evaluation. It could be linked to poor sleep habits, medication side effects, psychiatric conditions, or underlying sleep disorders such as obstructive sleep apnoea or narcolepsy.
What Happens If Your Score Is High?
If your Epworth Sleepiness Scale score exceeds 11, it is essential to identify the cause of excessive daytime sleepiness. Since excessive sleepiness is a symptom rather than a condition, further evaluation may be required. Your healthcare provider may suggest:
- A sleep study (polysomnography) is used to diagnose conditions such as obstructive sleep apnoea.
- A Multiple Sleep Latency Test (MSLT) assesses how quickly you fall asleep in a quiet environment during the day.
- Lifestyle modifications include improving sleep hygiene, adjusting medication, or managing stress levels.
Ignoring excessive daytime sleepiness can negatively impact daily life, increasing the risk of accidents, reduced concentration, and impaired cognitive function.
When to Consult Us
Consult a healthcare provider if excessive daytime sleepiness affects your ability to stay awake during routine activities or if you experience:
- Frequent dozing off in passive situations (e.g., watching TV, sitting in meetings).
- Difficulty concentrating or memory issues.
- Trouble staying awake while driving.
- Persistent fatigue despite getting adequate sleep.
If you score 11 or higher on the Epworth Sleepiness Scale, it is advisable to seek expert assistance. Manse Medical offers comprehensive sleep assessments, including diagnostic tests and personalised treatment plans, to help improve sleep quality and overall well-being.
Patients who cannot attend in-person consultations or prefer virtual appointments have telehealth services available. These consultations allow you to discuss your sleep concerns with a specialist from the comfort of your home. Book an online consultation to get expert guidance on managing excessive daytime sleepiness.
FAQs
Q1. What is a normal Epworth Sleepiness Scale?
An Epworth Sleepiness Scale (ESS) score ranges from 0 to 10, indicating low to moderate daytime sleepiness. This suggests a typical sleep-wake cycle. However, further assessment by a healthcare provider may be necessary if you experience poor sleep quality, frequent awakenings, or fatigue despite a standard score.
Q2. What is the sleepiness scale for OSA?
For Obstructive Sleep Apnea (OSA), an Epworth Sleepiness Scale score of 11 or higher suggests excessive daytime sleepiness, a common symptom of OSA. Patients with moderate to severe OSA often score 15 or above, indicating a high likelihood of sleep disturbances and needing further diagnostic testing, such as a sleep study.
Q3. How to calculate ESS score?
The Epworth Sleepiness Scale (ESS) score is calculated by adding up responses from eight questions, each rated on a 0 to 3 scale. The total score ranges from 0 to 24—higher scores indicate more significant daytime sleepiness. A score above 10 may require further medical evaluation for potential sleep disorders.
