Brief Description
The Epworth Sleepiness Scale (ESS) is a self-administered questionnaire that assesses an individual’s daytime sleepiness, or propensity to fall asleep during common activities. It consists of eight items, each describing a situation in which people may feel sleepy, such as sitting and reading, watching television, or being a passenger in a car. Respondents rate their likelihood of dozing off in each situation. The ESS is widely used in clinical settings to identify excessive daytime sleepiness, making it useful for diagnosing sleep disorders like narcolepsy or obstructive sleep apnea.
Assessment Administration Type
Self-report
Number of questions
8
Age Range for Administration
18+
Recommended Frequency of Administration
No recommended frequency; Blueprint recommends every other week or as clinically indicated.
Summary of Scoring and Interpretations
Each of the 8 items are scored using a 4-point scale ranging from 0 ("No chance of dozing") to 3 ("High chance of dozing"). Scoring the ESS involves summing the responses for all eight items, yielding a total score that can range from 0 to 24. Higher scores indicate greater levels of daytime sleepiness, with scores between 11 and 24 suggesting excessive daytime sleepiness (EDS). Scores below 10 are considered within the normal range. See the complete list of interpretations in the table below:
Score | Interpretation |
0-5 | Lower Normal Daytime Sleepiness |
6-10 | Higher Normal Daytime Sleepiness |
11-12 | Mild Excessive Daytime Sleepiness |
13-15 | Moderate Excessive Daytime Sleepiness |
16-24 | Severe Excessive Daytime Sleepiness |
In clinical practice, the ESS can help track changes in sleepiness over time, especially when comparing scores before and after interventions such as continuous positive airway pressure (CPAP) treatment. However, a high score does not necessarily indicate a specific sleep disorder, as other factors like depression or fatigue may also influence the results.
Blueprint Adjustments
Blueprint utilized a clinical cut-off score of 11 to indicate clinically significant excessive daytime sleepiness.
Clinical Considerations
Estimated time for completion: 2-4 minutes
The ESS is not appropriate for individuals with significant cognitive impairment.
The ESS is not designed to measure rapid fluctuations in sleep propensity over short periods, such as demonstrating the immediate sedative effects of a medication or evaluating the circadian rhythm of sleep propensity.
Gender and age have minimal impact on ESS scores in adults.
African Americans tend to have significantly higher ESS scores compared to Caucasian Americans. This could be due to culturally interpretative differences for questions 6 and 7 (Hayes, A.L., Spilsbury, J.C., Patel, S.R., 2009). Clinicians may consider implementing higher thresholds to diagnose pathological sleepiness in African American patients or using alternative measurements of sleepiness.
Citation
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