The Epworth Sleepiness Scale: An Important Tool

The Epworth Sleepiness Scale is a useful tool. As a self-administered questionnaire to measure your daytime fatigue, it not only raises awareness for underlying medical issues but also can help doctors in determining if you need further testing in the process of diagnosis. 

You might be wondering what we’re even talking about… so we’ll describe what exactly, the Epworth Sleepiness Scale is, how it scores, and what it could mean for you. 

What is the Epworth Sleepiness Scale (ESS)? 

The Epworth Sleepiness Scale is a self-administered questionnaire. It evaluates your daytime sleepiness levels. The questionnaire asks for rates on how likely you are to doze off in certain situations you encounter in daily life and then measures your “average sleep propensity.” 

The ESS was developed back in 1990 by Dr. Murray Johns to assess his adult patients’ levels of daytime fatigue. In 1997, the questionnaire was further modified for better accuracy. The questionnaire was named after Epworth Hospital in Melbourne, where Dr. Johns established Epworth Sleep Centre in 1988. 

While the ESS was developed specifically for adults in Dr. John’s sleep medicine practice, it has been validated for use in adolescents. There is also a modified version of the ESS, known as the ESS-CHAD, designed particularly for children and adolescents. In comparison, this version has questions with life situations that might be more relatable for these younger age groups than what is mentioned in the ESS.

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Because excessive daytime fatigue has been associated with many underlying conditions, including sleep disorders, the goal of this questionnaire is to help you gain a better understanding of your risk for these types of issues. It also can help a doctor in the process of diagnosing a patient by offering extra information pertaining to fatigue levels.

What Questions Does the ESS Ask? 

The ESS has eight questions where you are asked to rate on a scale of 0 to 3 your chances of dozing off while occupied with an activity. The activities mentioned in the ESS are:

  • Sitting and reading
  • Watching TV
  • Sitting inactive in a public place, such as a library or movie theater 
  • Riding as a passenger in a car for an hour 
  • Lying down to rest in the afternoon
  • Sitting down and talking to someone
  • Sitting quietly after lunch (without alcohol consumption)
  • Sitting in a car, stopped at a stoplight or in traffic

The activities picked for these questions were chosen because they have a wide range of “somnificities.” 

Somnificity is the term created by Dr. Johns to regard differences in posture that affect how quickly you fall asleep. For example, an activity like lying down to rest has a much higher somnoficity (so you are more ready to fall asleep) than sitting and talking with someone. 

Your score is an estimate of how likely you are to fall asleep during these types of situations. If you have a high score, your daytime fatigue levels are greater. 

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Scoring and Interpretation 

You answer the questions by giving a score between 0 and 3, which indicates how likely you are to fall asleep. The scoring for ESS is as follows:

  • 0 = would never doze 
  • 1 = slight chance of dozing 
  • 2 = moderate chance of dozing 
  • 3 = high chance of dozing 

Your score at the end of the ESS is the sum of these individual scores. Your total score can range 0-24, with 0 being no daytime sleepiness and 24 being an abnormally intense amount of daytime sleepiness.

The interpretation of the total score is as follows:

  • 0 to 10: normal amount of sleepiness for adults 
  • 11 to 14: mild sleepiness 
  • 15 to 17: moderate sleepiness 
  • 18 to 24: severe sleepiness 

Health Conditions 

The ESS can indicate if you are suffering from an underlying medical condition that contributes to your daytime fatigue. A score of 11 or higher usually means there is an excessive amount of daytime fatigue that could be a sign of a medical condition and visiting a sleep specialist is recommended. Here are some things a high score on the ESS could indicate:

  • Sleep apnea, a sleep disorder characterized by episodes of insufficient breathing, where a person stops breathing throughout the night 
  • Narcolepsy, a neurological disorder where a person can fall asleep and awaken from a deep sleep at any point in time throughout the day, while doing any activity 
  • Hypersomnia, excessive daytime fatigue even after a full night’s sleep 
  • Other medical conditions like Parkinson’s disease 
  • Mental health conditions like anxiety disorder or depression

Some medications and excessive alcohol or drug consumption could also be causing daytime fatigue. 

The Accuracy of the ESS

Many studies have validated this questionnaire. Using the ESS in conjunction with other objective sleepiness tests, such as the Multiple Sleep Latency Test (MSLT) and sleep studies, has also supported the Epworth Sleepiness Scale’s validity. 

With that said, while the test is definitely reliable for measuring daytime fatigue, it may not be the most reliable resource for diagnosing or predicting sleep disorders in particular. This is due to the many other health conditions associated with and causes of excessive daytime fatigue. 

Something to keep in mind is that, due to the test being self-administered, the score is based on subjective reports. The test’s scoring might be more accurate if it is physician-administered; one study looked at which scores were more accurate in people with suspected obstructive sleep apnea, and the physician-administered scores were in fact of higher accuracy.

Regardless, the questionnaire is an important screening tool that can help you recognize your own sleep propensity as well as help you determine if you need to seek a professional’s help in combating daytime fatigue.  Additionally, it is a practical tool that doctors can use to aid in their diagnosing processes.

Feeling Sleepy? Visit Us! 

You can take the ESS here. If your score is above 11, don’t just dismiss it! 

If you are struggling with excessive daytime fatigue or are experiencing symptoms of a sleep disorder, take action today. Don’t let improper sleep ruin your success! At Advanced Sleep Centers of Virginia, we have a highly-trained team of sleep specialists dedicated to your health. We make treating and diagnosing sleep disorders, chronic snoring, and more as easy as possible with at-home sleep tests, online scheduling, and a secure telemedicine portal where you can talk to a professional privately. 

Your comfort, convenience, and quality sleep are our first priority! 

Worried about your quality of sleep? Feeling sleepy all day long? We’re here to help. You can schedule an appointment with us online or call us at (703) 689-2480 for a free consultation. 

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