Developed in 1990 by an Australian doctor Murray Johns, the Epworth Sleepiness Scale (ESS) is today widely used for assessing daytime sleepiness in a person. This is a self-administered questionnaire and the person who is filling the questionnaire will need to rate themselves on how likely they are to fall asleep during the day in different situations. The questionnaire is used to assess if you suffer from a sleep disorder or if you are having any other underlying medical condition.
Understanding the Epworth Sleepiness Scale test can help doctors with their diagnosis and it can also help you understand whether you are suffering from daytime sleepiness or symptoms of some other sleep disorder.
What is the Epworth Sleepiness Scale (ESS) Test?
The Epworth Sleepiness Scale (ESS) Test is a self-administered questionnaire that doctors routinely use for diagnosing daytime sleepiness and other sleep disorders. The Epworth Sleepiness Scale (ESS) Test was designed by an Australian doctor Murray Johns in 1990 and was named after his establishment, the Epworth Sleep Center.
The Epworth Sleepiness Scale (ESS) questionnaire is designed with a set of questions that requires the person filling it to rate themselves on how likely are they to fall asleep during the daytime when in different situations.
The ESS questionnaire was originally created for adults, but in many studies pertaining to adolescents, the questionnaire has been used successfully to determine whether they are having daytime sleepiness. There is also another modified version of this test, known as the ESS-CHAD that was created for adolescents as well as children.(1) This version of the test is also very similar to the ESS questionnaire for adults, but the activities and instructions on the questionnaire have been modified to make it more relatable to adolescents and children, and also made it easier for them to understand.
Daytime sleepiness, which is typically classified with the help of the Epworth Sleepiness Scale (ESS) questionnaire, is a sign of a potential sleep disorder or some other underlying medical condition. Your doctor will use your answers to this questionnaire to diagnose a sleep disorder and also monitor your response to any treatment plan.
Where Can You Find The Epworth Sleepiness Scale (ESS) Questionnaire?
The Epworth sleepiness scale questionnaire is made up of only eight questions. You are asked to rate your typical chances of having fallen asleep or dozed off while you were engaged in certain different activities. You have to rate your likelihood on a scale of 0 to 3. Some of the activities that are included in the questionnaire include:
- Watching TV.
- Sitting and reading.
- Sitting and talking to someone.
- Riding as a passenger in a car without a break for an hour.
- Sitting ideally or in an inactive manner in a public place, such as a theatre or a meeting.
- Lying down to take rest in the afternoon when your situation permits.
- Sitting quietly after taking your lunch, but without any alcohol intake.
- Sitting in a car that has stopped at the traffic signal for a couple of minutes.
The level of these activities all varies in their somnificity. Somnificity is a term that was introduced by Dr. Murray Johns himself, the creator of his test. The term is used to describe how different activities and postures affect your body’s readiness to doze off or fall asleep.
The score of the Epworth sleepiness scale test provides a good estimate to doctors on how likely you are to doze off during everyday routine situations in your day-to-day life. The higher the score you have, the higher is your daytime sleepiness.
The Epworth sleepiness scale (ESS) questionnaire can be found easily from the American Sleep Apnea Association(2) or also through the Division of Sleep at the Harvard Medical School.(3) It is available as a form that you can download.
Understanding the Scores and Interpretation of the Results of the Epworth Sleepiness Scale (ESS) Test
Each of the specific activities that are listed on the Epworth sleepiness scale (ESS) questionnaire is assigned a score from 0 to 3. The score indicates how likely you are to fall asleep during any of the activities. The scores indicate the following:
- 0 – Unlikely to never doze off.
- 1 – Has a slight chance of dozing off.
- 2 – Has a moderate chance of dozing off.
- 3 – Has a very high chance of dozing off.
The total score a person can get ranges from 0 to 24 and the higher the score, the greater the chances of increased sleepiness during the day.
Your score from the Epworth sleepiness scale (ESS) questionnaire is interpreted in the following manner:
- 0 to 10 – This indicates a normal range of sleepiness in most healthy adults.
- 11 to 14 – This indicates mild sleepiness.
- 15 to 17 – This indicates a moderate level of sleepiness.
- 18 to 24 – This score indicates a severe level of sleepiness.
What Medical Conditions Can Epworth Sleepiness Scale (ESS) Indicate?
An Epworth sleepiness scale (ESS) score of 11 or above typically indicates that you suffer from excessive daytime sleepiness, which could be a potential symptom of a sleep disorder or any other underlying medical condition. If you have got a score of 11 or higher, then your doctor is likely to recommend that you visit a sleep specialist who will then run other tests to determine what sleep disorder you have.
What Conditions Cause Excessive Sleepiness During The Daytime?
Here are some of the medical conditions that can cause excessive sleepiness during the daytime:(4)
- Narcolepsy: This is a neurological condition that causes sleep attacks. During these sleep attacks, a person is able to fall into and awake from a REM sleep cycle during any time of the day and also during any activity.
- Hypersomnia: This is a type of sleep disorder that causes excessive daytime sleepiness, even after you have had a good long night of sleep.
- Sleep Apnea: This is a type of sleeping disorder in which a person stops breathing involuntarily for short periods of time during sleep.
Some other factors that can also cause excessive daytime sleepiness include:
- Mental health conditions, such as depression.
- Medical conditions, such as Parkinson’s disease and cancer.
- Certain types of medications, such as antidepressants, antihistamines and adrenergic drugs.
- Excessive drug and alcohol usage.
How Accurate is the Epworth Sleepiness Scale (ESS) Test?
Many studies have established the accuracy of the ESS test and several objective sleepiness tests, such as the multiple sleep latency test (MSLT) have also proven the validity of the Epworth sleepiness scale (ESS) test. While it has been shown that the Epworth Sleepiness Scale (ESS) questionnaire is a reliable method of measuring daytime sleepiness, there is some evidence that it might not be the most reliable predictor of sleep disorders, especially narcolepsy and sleep apnea.
Epworth sleepiness scale (ESS) test is an effective screening tool, but it is not meant to be used as the only diagnostic tool for diagnosing sleep disorders. This is because the Epworth Sleepiness Scale (ESS) Test is unable to distinguish which sleep disorders or which factors are causing a person to experience excessive sleepiness during the day. The questionnaire is also self-administered, due to which the scores are based only on subjective reporting.
In fact, in 2013, a study carried out by the Johns Hopkins University tried exploring whether or not filling up the questionnaire administered by a doctor rather than self-administering the questionnaire, proved to be more accurate in people. The results of the study definitely showed that when the questionnaire was administered by a physician, the scores were more accurate. This suggested that having a physician administer the questionnaire, will make the Epworth sleepiness scale (ESS) test even more reliable in diagnosing or predicting sleep apnea.(5)
The Epworth Sleepiness Scale Test is not exactly a diagnostic tool and it cannot be used to diagnose a sleep disorder. However, the ESS questionnaire can be used successfully as a screening tool that will help your doctor find out whether or not you need further testing for diagnosing sleep disorders. In most cases, your doctor will refer you for a sleep study to diagnose a sleep disorder.(6)
There are many factors that can have an influence on your test results and cause you to score higher. This also includes occasional insomnia.
If you are worried about having a sleep disorder or if you feel that you are suffering from excessive daytime sleepiness or you have a poor quality of sleep in general, then you must consult your doctor, regardless of what the results of the ESS questionnaire reveal.
- Epworthsleepinessscale.com. (2019). About the ESS-CHAD – Epworth Sleepiness Scale. [online] Available at: http://epworthsleepinessscale.com/about-the-ess-chad/ [Accessed 20 Apr. 2019].
- Sleepapnea.org. (2019). [online] Available at: http://www.sleepapnea.org/wp-content/uploads/2017/02/ESS-PDF-1990-97.pdf [Accessed 20 Apr. 2019].
- Healthysleep.med.harvard.edu. (2019). Epworth Sleepiness Scale | Narcolepsy. [online] Available at: http://healthysleep.med.harvard.edu/narcolepsy/diagnosing-narcolepsy/epworth-sleepiness-scale [Accessed 20 Apr. 2019].
- Cai, S.J., Rui, C.H.E.N., Zhang, Y.L., Xiong, K.P., Lian, Y.X., Jie, L.I., Shen, J.C. and Liu, C.F., 2013. Correlation of Epworth Sleepiness Scale with multiple sleep latency test and its diagnostic accuracy in assessing excessive daytime sleepiness in patients with obstructive sleep apnea hypopnea syndrome. Chinese medical journal, 126(17), pp.3245-3250.
- Kaminska, M., Jobin, V., Mayer, P., Amyot, R., Perraton-Brillon, M. and Bellemare, F., 2010. The Epworth Sleepiness Scale: self-administration versus administration by the physician, and validation of a French version. Canadian respiratory journal, 17(2), pp.e27-e34.
- Punjabi, N.M., Aurora, R.N. and Patil, S.P., 2013. Home sleep testing for obstructive sleep apnea: one night is enough!. Chest, 143(2), pp.291-294.