The Epworth Sleepiness Scale (ESS) Test

Do you find it hard to stay awake during the day? Is your daytime drowsiness normal? The Epworth Sleepiness Scale (ESS) measures your level of daytime sleepiness. We’ll help you understand what the ESS is, how you can take the test, and what to do with your test results.

What is the Epworth Sleepiness Scale (ESS)? 

The ESS is a tool designed to assess a patient’s level of daytime lethargy. There is a separate version for use with children and adolescents called the Epworth Sleepiness Scale – Child Adolescent (ESS-CHAD). The ESS is a self-administered questionnaire that puts your daytime sleepiness on a scale. Understanding how serious your daytime sleepiness is can help you and your doctor understand if you might have an underlying sleep disorder.

These scales were developed in 1990 by Dr. Murry W Johns, at the Epworth Hospital in Melbourne, Australia. Dr. Johns was the first person in Australia to complete a doctorate in sleep medicine, going on to develop the Epworth Sleep Centre and to pioneer work around sleep with a special interest in “sleepiness” or drowsiness.  He was influenced by patients who had nodded off while driving, or had “drowsy driving” accidents, and developed the scale to assist in assessing patients for treatment. It was the first tool of its kind; he named the scale after the hospital and sleep centre where he was working. Dr. Johns retired in 2002 after decades in clinical practice.

How the ESS Scale Works

Established in collaboration with the hospital sleep clinic, the Epworth Sleepiness Scale was designed to measure, “average sleep propensity in daily life,” or daytime sleepiness. A more contemporary term might be “daytime fatigue,” or the desire to nod off, but in essence the scale rates the levels of sleepiness one might experience during a normal day and in ordinary circumstances.

The scale is a questionnaire where a person self-rates certain situations based on how likely it is they would fall asleep during them. It asks specifically if you would be inclined to doze off during routine situations like watching television, talking with a friend, or being stopped in traffic. Your final score tells how likely it is you have abnormal sleepiness and thus might need medical attention.

This assessment tool allows doctors to get a good idea of individual levels of challenge with daytime sleepiness and assist in treating accordingly. High levels on the test might indicate more serious conditions like narcolepsy, which can cause a person to fall asleep uncontrollably, often times putting the person in peril. It allows physicians to intervene early on with medication or other treatments to keep patients safe.

The Epworth Sleepiness Scale is still used today world-wide. It plays a critical role in establishing diagnostic criteria in sleep clinics, and giving doctors vital information about an overall pattern of daytime sleepiness in their patients. This information is then utilized for corrective treatment where needed.

How to Take the ESS

The ESS self-assessment has eight questions. You will rate your chance of falling asleep during different types of activities on a scale of 0 to 3. You will be asked to rate your likelihood of falling asleep while sitting and reading, watching TV, sitting inactive in a public place (ex. theatre or a meeting), sitting as a passenger in a car for an hour without a break, lying down to rest in the afternoon, sitting and talking to someone, sitting quietly after a lunch (without alcohol), and in a car while stopped in traffic for a few minutes.

There are several places online where you can download the ESS test to take it for yourself:

• American Sleep Apnea Association
• National Association of State EMS Officials
• Centers for Disease Control and Prevention (CDC)

Calculating and Interpreting the Score

You will rate your likelihood of falling asleep during each of these activities of varying somnificity on a scale from 0 to 3:

• 0: Would never doze
• 1: Slight change of dozing
• 2: Moderate chance of dozing
• 3: High chance of dozing

Then, you will calculate your total score, which will range from 0 to 24. The higher the score, the more daytime sleepiness you experience. The final step is analyzing and interpreting your ESS test scores. Use the following scales to understand your results:

• 0-7: You are not abnormally sleepy.
• 8-9: Average amount of daytime sleepiness.
• 10-15: You are moderately sleepy during the day. You may want to seek medical advice.
• 16-24: You are experiencing excessive daytime sleepiness and should consult with a medical professional.

What Does it Mean if You are Excessively Sleepy?

If you have a high score on the ESS in the upper ranges between 15-24, you may be experiencing excessive daytime sleepiness due to a sleep disorder or other health condition. Excessive daytime sleepiness can be an indicator of many different types of health concerns including:

• Mental health conditions such as anxiety or depression
• A side effect of certain medications
• Excessive drug or alcohol use
• Medical conditions like cancer or Parkinson’s disease

Excessive daytime sleepiness is also often associated with sleep disorders. Common sleep disorders include hypersomnia, sleep apnea, and narcolepsy. If you think you may have a sleep disorder, speak with your primary care physician. They may refer you to a sleep clinician or recommend an overnight sleep study to understand and diagnose your condition before treatment.

Summary

The Epworth Sleepiness Scale (ESS) can help you determine if you have a mild, average, or excessive amount of daytime sleepiness. This self-assessment can be useful to help you understand if your sleepiness is serious enough to visit a doctor, or it can be a useful indicator for your doctor to understand your symptoms.

If you are ever concerned about your sleepiness or any other health factors, it is always best to seek medical advice.