The Epworth Sleepiness Scale

How tired is too tired during the day?

By Sheryl Grassie

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.

The Epworth Sleepiness Scale

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).

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 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.

Journal of Clinical Sleep Medicine

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.


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