The Epworth Sleepiness Scale: Daytime Sleepiness Danger
I was diagnosed with severe sleep apnea almost 10 years ago now, and I had some of the systems of the Epworth Sleepiness Scale before I received my CPAP treatment.
I woke up tired every day and couldn’t concentrate at work. I had to shake my head to wake up whilst driving.
This is obviously very serious and the Epworth Sleepiness Scale can help form a diagnosis, which is what I’ll cover in this article.
Excessive daytime sleepiness is a common symptom of various sleep disorders, including obstructive sleep apnea (OSA), insomnia, and narcolepsy.
This simple, self-administered questionnaire helps to quantify how likely a person is to fall asleep during various activities in everyday life.
So how is the ESS system used, and why it’s important in the diagnosis of sleep disorders?
What Is the Epworth Sleepiness Scale?
The Epworth Sleepiness Scale (ESS) is a questionnaire that assesses a person’s daytime sleepiness by measuring how likely they are to doze off in different situations.
The ESS system was developed in 1991 by Dr. Murray Johns, to help sleep specialists determine whether a patient’s sleepiness is within a normal range or indicative of a sleep disorder.
The questionnaire consists of eight scenarios, each representing a common situation where people might feel drowsy. Patients are asked to rate how likely they are to fall asleep in each situation, using a scale from 0 to 3, where:
- 0 = No chance of dozing.
- 1 = Slight chance of dozing.
- 2 = Moderate chance of dozing.
- 3 = High chance of dozing.
The total score ranges from 0 to 24, with higher scores indicating more severe daytime sleepiness.
The Epworth Sleepiness Scale Questions
Here are the eight scenarios you’ll encounter on the Epworth Sleepiness Scale:
| Situation | Chance of Dozing (0-3) |
|---|---|
| Sitting and reading | |
| Watching TV | |
| Sitting, inactive, in a public place (e.g., theater or 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 lunch without alcohol | |
| In a car, while stopped for a few minutes in traffic |
The score for each situation is added together to determine the total ESS score.
How to Interpret the Epworth Sleepiness Scale
Once you’ve completed the Epworth Sleepiness Scale, the total score can help assess your level of daytime sleepiness. Here’s how to interpret the results:
| ESS Score | Level of Daytime Sleepiness | Possible Next Steps |
|---|---|---|
| 0-5 | Lower than average daytime sleepiness | Generally no cause for concern |
| 6-10 | Normal daytime sleepiness | No immediate action needed, but consider lifestyle factors like sleep habits |
| 11-12 | Mild excessive daytime sleepiness | Potential concern—consider speaking with a healthcare provider |
| 13-15 | Moderate excessive daytime sleepiness | Evaluation for a sleep disorder may be necessary |
| 16-24 | Severe excessive daytime sleepiness | High likelihood of a sleep disorder—consult a healthcare provider for further testing |
A score of 11 or higher may indicate excessive daytime sleepiness and the need for further evaluation, particularly if symptoms like snoring, pauses in breathing during sleep, or other signs of sleep disorders are present.
Why Is the Sleepiness Scale Important?
The Epworth Sleepiness Scale is a valuable tool for both patients and healthcare providers because it offers a quick and reliable way to measure daytime sleepiness. Here are some reasons why it’s an important part of sleep disorder evaluation:
1. Identifying Sleep Disorders
Daytime sleepiness can be caused by a range of sleep disorders, including obstructive sleep apnea (OSA), narcolepsy, insomnia, and restless legs syndrome. The ESS helps flag whether daytime sleepiness is outside the normal range, prompting further investigation into the cause.
2. Evaluating Treatment Effectiveness
For individuals already diagnosed with a sleep disorder, the ESS can be used to track how well a treatment is working. For example, someone undergoing CPAP therapy for sleep apnea can retake the Epworth Sleepiness Scale after a few weeks to see if their daytime sleepiness has improved.
3. Raising Awareness of Sleep Health
Many people don’t realize how much their daytime sleepiness impacts their quality of life. The ESS helps bring attention to this issue and encourages individuals to seek help if their sleepiness is affecting daily activities or work.
Limitations of the Epworth Sleepiness Scale
While the Epworth Sleepiness Scale is a useful screening tool, it has some limitations. The ESS relies on the subjective assessment of the patient, which means that it can be influenced by personal bias or an individual’s perception of their sleepiness.
Additionally, the scale does not identify the underlying cause of daytime sleepiness; it only indicates whether further evaluation may be necessary.
When to Seek Further Evaluation
If your Epworth Sleepiness Scale score is 11 or higher, and especially if you’re experiencing other symptoms like loud snoring, gasping for air during sleep, or waking up feeling unrefreshed, it’s important to consult with a healthcare provider. They may recommend a sleep study or other tests to diagnose the cause of your sleepiness.
Conclusion: A Simple but Effective Tool
The Epworth Sleepiness Scale is a simple, straightforward tool that helps assess the severity of daytime sleepiness and flags potential sleep disorders.
If you’re experiencing excessive sleepiness or think you may have a sleep disorder, completing the ESS is a great first step in understanding your sleep health.
From there, a healthcare provider can help you take the next steps toward diagnosis and treatment.
Let me know in the comments if you have taken the Epworth Sleepiness Scale test and how you got on.
