Understanding the Epworth Sleepiness Scale

What Is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale (ESS) is a short questionnaire developed in 1991 by Dr. Murray Johns at Epworth Hospital in Melbourne, Australia. It asks you to rate how likely you are to doze off in eight everyday situations. The total score ranges from 0 to 24.

Doctors and sleep specialists use the ESS as a quick screening tool to measure subjective daytime sleepiness. It does not diagnose any condition, but a high score can signal that a conversation with a healthcare provider is worthwhile.

Take the Epworth Sleepiness Scale now to see where you fall.

How the Scoring Works

Each of the eight situations is rated on a 0 to 3 scale:

• 0 means you would never doze in that situation
• 1 means there is a slight chance you would doze
• 2 means there is a moderate chance
• 3 means there is a high chance

The scores are added together for a total between 0 and 24.

What Your Score Means

The ESS groups scores into four general ranges. These are guidelines, not diagnoses.

0 to 7: Normal. Your daytime alertness is within the range most people report. Feeling sleepy in a warm room after lunch is not the same as problematic sleepiness.

8 to 9: Average. This is the population average. Most adults fall somewhere in this range. It does not indicate a sleep disorder.

10 to 15: Elevated. You may be experiencing more daytime sleepiness than average. This does not mean you have a sleep disorder, but it is worth discussing with a healthcare provider, especially if the sleepiness affects your daily life, your driving, or your work.

16 to 24: High. Scores in this range suggest significant daytime sleepiness. A conversation with a healthcare provider about your sleep quality is strongly recommended. They may suggest a sleep study to look for underlying causes.

What the ESS Does Not Tell You

The ESS measures how sleepy you feel during the day. It does not:

• Diagnose sleep apnea or any other sleep disorder
• Measure sleep quality or sleep duration
• Replace a sleep study
• Account for caffeine, medications, or shift work that may mask or amplify sleepiness

A normal ESS score does not rule out sleep apnea. Many people with sleep apnea report low ESS scores because they have adapted to chronic sleepiness, or because caffeine masks the symptoms. If your partner notices loud snoring, gasping, or breathing pauses during sleep, a screening conversation with your doctor is still important regardless of your ESS score.

When to See a Doctor

Consider scheduling an appointment if:

• Your ESS score is 10 or higher
• You feel unrefreshed after a full night of sleep
• You struggle to stay awake while driving or at work
• A bed partner has noticed snoring, gasping, or pauses in your breathing
• You wake up with headaches or a dry mouth regularly

Your doctor can determine whether a home sleep test or in-lab study is appropriate based on your symptoms and history.

Using the ESS with CPAP Therapy

If you already use a CPAP machine, the ESS can help you and your doctor gauge whether your therapy is effectively reducing daytime sleepiness. A high ESS score despite consistent CPAP use could indicate that your pressure settings need adjustment, your mask fit is compromising therapy, or there is another factor worth investigating.

You can analyze your CPAP data to see whether your nightly metrics align with how you feel during the day.