Epworth Sleepiness Scale

Measure daytime sleepiness. Used to screen for obstructive sleep apnea, narcolepsy, and other sleep disorders. Patient self-report.

Indication

Measure daytime sleepiness. Used to screen for obstructive sleep apnea, narcolepsy, and other sleep disorders. Patient self-report.

Criteria

id: ess_1; label: 1. Sitting and reading; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_2; label: 2. Watching TV; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_3; label: 3. Sitting inactive in a public place (theater or meeting); type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_4; label: 4. As a passenger in a car for an hour without a break; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_5; label: 5. Lying down to rest in the afternoon when possible; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_6; label: 6. Sitting and talking to someone; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_7; label: 7. Sitting quietly after lunch without alcohol; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance
id: ess_8; label: 8. In a car, while stopped for a few minutes in traffic; type: options; options: value: 0; label: 0 — Would never doze; value: 1; label: 1 — Slight chance; value: 2; label: 2 — Moderate chance; value: 3; label: 3 — High chance

Interpretation

function(score) { if (score <= 10) return { risk: score + '/24', tier: 'Normal daytime sleepiness', action: 'Within normal range. Reassess if symptoms develop.', color: 'green' }; if (score <= 12) return { risk: score + '/24', tier: 'Mild excessive sleepiness', action: 'Monitor; lifestyle counseling (sleep hygiene).', color: 'yellow' }; if (score <= 15) return { risk: score + '/24', tier: 'Moderate excessive sleepiness', action: 'Sleep study recommended. Screen for OSA (STOP-BANG).', color: 'yellow' }; return { risk: score + '/24', tier: 'Severe excessive sleepiness', action: 'Urgent sleep evaluation. Advise to avoid driving until evaluated.', color: 'red' }; }

Clinical pearls

ESS measures average daytime sleepiness, not situational alertness
20–30% of OSA patients have a normal ESS — do not use it to rule out OSA
ESS ≥11 with STOP-BANG ≥3 has high sensitivity for OSA
CPAP therapy typically reduces ESS by 4–5 points — valuable for monitoring response

Source and review

Johns MW. Sleep 1991. Last reviewed: 2025-01-01