Epworth Sleepiness Scale (ESS): Score and Severity

What it measures

The Epworth Sleepiness Scale is a self-report screen for daytime sleepiness. The patient rates how likely they are to doze off or fall asleep, not just feel tired, in eight common situations: sitting and reading; watching TV; sitting inactive in a public place such as a meeting or theater; riding as a passenger in a car for an hour or more without a break; lying down to rest when circumstances permit; sitting and talking to someone; sitting quietly after a meal without alcohol; and in a car while stopped for a few minutes in traffic or at a light. If they have not been in a situation recently, they estimate how it would affect them.

Items and scoring

Each item is scored 0 (would never nod off), 1 (slight chance), 2 (moderate chance) or 3 (high chance). The total runs from 0 to 24. The tool shows the running total as you go and assigns a band only after all eight items are answered.

Total	Band
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

A total above 10 indicates excessive daytime sleepiness. For the higher bands the tool suggests reviewing sleep, medication and medical contributors, and considering sleep-medicine evaluation, especially when driving or work safety is involved.

What the report includes

The copied report gives the date, total out of 24, severity band, a suggested action, each item's response, and the scoring note with the source citation (Johns MW, Sleep, 1991). It is plain text for pasting into an EMR. A blank printable form is also available from the tool header.

Limitations

The ESS screens for sleepiness. It does not diagnose a sleep disorder. A high score calls for a formal sleep evaluation and a review of sedating medications, and a normal score does not rule out a sleep disorder when other symptoms point to one.