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Epworth Sleepiness Scale

A validated screening tool used by doctors worldwide to measure daytime sleepiness.

How likely are you to doze off or fall asleep in the following situations, in contrast to just feeling tired? Even if you have not done some of these things recently, think about how they would have affected you.

1.Sitting and reading

2.Watching TV

3.Sitting inactive in a public place (e.g., a theater or meeting)

4.As a passenger in a car for an hour without a break

5.Lying down to rest in the afternoon when circumstances permit

6.Sitting and talking to someone

7.Sitting quietly after a lunch without alcohol

8.In a car, while stopped for a few minutes in traffic

What This Tool Measures

The Epworth Sleepiness Scale (ESS) measures your general level of daytime sleepiness by asking how likely you are to doze off in eight common everyday situations. Unlike questions about whether you feel tired (which is subjective and culturally variable), the ESS asks about specific, concrete scenarios that most people encounter regularly. Your total score (0 to 24) indicates whether your daytime sleepiness falls within a normal range or suggests a sleep disorder that warrants investigation.

Clinical Background

The Epworth Sleepiness Scale was developed by Dr. Murray Johns at the Epworth Hospital in Melbourne, Australia, and published in the journal Sleep in 1991. It was designed to provide a simple, standardized measure of sleepiness that could be used in both clinical practice and research. The original validation study compared ESS scores against objective sleep latency measurements (the Multiple Sleep Latency Test, or MSLT) and found a significant correlation between the two.

The ESS has since been validated in dozens of studies across multiple countries and languages. It is the most widely used subjective sleepiness measure in sleep medicine. The American Academy of Sleep Medicine (AASM) recommends the ESS as part of the clinical evaluation for suspected sleep disorders.

One important limitation: the ESS measures general sleepiness tendency, not moment-to-moment alertness. A person who slept poorly last night might still have a low ESS score if their overall sleep pattern is healthy. Conversely, someone with untreated sleep apnea may have adapted to chronic sleepiness and rate themselves lower than their objective impairment would suggest.

Scoring and Interpretation

Each of the eight situations is rated 0 to 3, giving a total score range of 0 to 24. The published interpretation:

  • 0 to 7: Unlikely abnormal sleepiness. Your daytime sleepiness is within the normal range for healthy adults.
  • 8 to 9: Average daytime sleepiness. Borderline. Most people experience this level occasionally, but persistent scores in this range may warrant attention.
  • 10 to 15: Possible excessive sleepiness. Consider discussing your sleep quality with a healthcare provider, especially if you snore or have other sleep apnea risk factors.
  • 16 to 24: Excessive sleepiness. Strongly associated with a sleep disorder. Evaluation with a sleep study is recommended.

These thresholds are based on the original Johns (1991) scoring and are consistent with AASM clinical practice guidelines. The mean ESS score in healthy adults without sleep disorders is approximately 5.9 (Johns, 1991).

Tracking Your Score Over Time

The ESS is particularly useful as a before-and-after measure for CPAP therapy. Many sleep clinicians ask patients to take the ESS at diagnosis and again 30 to 90 days after starting treatment. A reduction of 2 or more points is generally considered clinically meaningful. If you are already using CPAP, consider retaking this questionnaire periodically. If your score is not improving or is getting worse, it may indicate suboptimal therapy (insufficient pressure, high leak, low usage hours) or a coexisting condition contributing to your sleepiness.

Frequently Asked Questions

What is a normal Epworth Sleepiness Scale score?

A score of 0 to 7 is considered normal and indicates unlikely abnormal sleepiness. Scores of 8 to 9 are average and represent a borderline level of daytime sleepiness that most people experience occasionally. Scores of 10 to 15 suggest possible excessive sleepiness that warrants further evaluation. Scores of 16 to 24 indicate significant excessive sleepiness that is strongly associated with a sleep disorder.

Can my Epworth score change over time?

Yes. The ESS measures your current level of daytime sleepiness, which can change with treatment, lifestyle changes, or new health conditions. Many sleep clinicians use the ESS before and after starting CPAP therapy to track improvement. A drop of 2 or more points after starting treatment is generally considered clinically meaningful. Retaking the questionnaire every few months can help you and your provider track whether therapy is reducing your daytime sleepiness.

Does a high Epworth score mean I have sleep apnea?

Not necessarily. The Epworth Sleepiness Scale measures daytime sleepiness, which can be caused by many conditions: obstructive sleep apnea, insufficient sleep duration, narcolepsy, shift work, medications (antihistamines, benzodiazepines, some antidepressants), depression, or chronic fatigue syndrome. A high ESS score is a signal to investigate the cause of your sleepiness, not a diagnosis of any specific condition. A sleep study is needed to confirm or rule out sleep apnea.

How is the Epworth Sleepiness Scale different from the STOP-BANG?

The ESS measures subjective daytime sleepiness by asking how likely you are to doze in eight everyday situations. The STOP-BANG questionnaire screens for obstructive sleep apnea risk using anatomical and demographic factors (snoring, BMI, neck size, age, sex). A person can have severe sleep apnea with a normal Epworth score if their body has adapted to chronic sleep fragmentation. The two tools measure different things and are often used together in clinical practice.

Should I take the Epworth Sleepiness Scale before seeing a doctor?

Taking the ESS before your appointment gives your provider useful baseline data and can help focus the conversation. Many sleep specialists ask patients to complete the ESS as part of their intake paperwork. Having your score ready saves time and shows you are engaged in the diagnostic process. Print or screenshot your results to bring to the appointment.

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