Epworth Sleepiness Scale

The Epworth Sleepiness Scale (ESS) measures the general level of daytime sleepiness. It is a subjective scale that asks the respondent to rate his or her propensity to doze or fall asleep during 8 common daily activities to determine the level of daytime sleepiness.1

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AASM, American Academy of Sleep Medicine.

Features of the ESS

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Purpose:

Designed to measure general level of daytime sleepiness1

Population:

All patients for whom the clinician may want to evaluate the level of daytime sleepiness1

Assessments:

Assesses the responder's propensity to doze or fall asleep during 8 common daily activities, such as: sitting and reading; sitting inactive in a public place; sitting and talking to someone; sitting quietly after a lunch without alcohol; or in a car, while stopped for a few minutes in traffic1,3

Method:

Patient self-report1

Time required:

Consists of 8 questions and takes only a few minutes to complete1

Scoring:

Propensity for dozing is rated for each situation on a 4-point scale, from 0, indicating “would never doze,” to 3, indicating a “high chance of dozing.” Adding the scores for each of the 8 questions yields a total score ranging from 0-24.1,3

Interpretation:

An ESS score >10 suggests excessive daytime sleepiness (EDS).2 An ESS score ≥16 suggests a high level of EDS.1 Scores within this range are generally associated with significant sleep disorders, including narcolepsy.1 A high ESS score is suggestive of EDS only and is not diagnostic for a specific sleep disorder. Patients with EDS (ie, ESS >10) may need to be evaluated for a potential sleep disorder, including narcolepsy.1,3

A narcolepsy diagnosis should be established by a sleep specialist using a clinical interview and a nighttime polysomnogram (PSG) followed by a multiple sleep latency test (MSLT) performed under standardized conditions.4

The Epworth Sleepiness Scale is from: Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545. This copyrighted material is used with permission granted by the Associated Professional Sleep Societies - October 2012. Unauthorized copying, printing, or distribution of this material is strictly prohibited.

  1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545.
  2. Krahn LE, Hershner S, Loeding LD, et al. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med. 2015;11(3):335-355.
  3. Johns M, Hocking B. Excessive daytime sleepiness: daytime sleepiness and sleep habits of Australian Workers. Sleep. 1997;20(10):844-849.
  4. American Academy of Sleep Medicine. Central disorders of hypersomnolence. In: The International Classification of Sleep Disorders – Third Edition (ICSD-3) Online Version. Darien, IL: American Academy of Sleep Medicine; 2014.