Many sleep disorders are characterized by patients suffering from excessive daytime sleepiness. When sleep clinics receive calls from patients concerned that their sleep troubles may be a sign of a sleep disorder, many patients will be given a generalized screening questionnaire asking them about their symptoms.

While there are a few different screening processes that sleep clinics may use, the Epworth Sleepiness Scale is the standard method of assessment in the world of sleep medicine.

What is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale (ESS) was first introduced in 1991 by Dr. Murray Johns of the Epworth Hospital in Melbourne, Australia, and is a tool used to measure the average sleep propensity (ASP) of patients to assess their general level of sleepiness and determine if sleep disorders could be the cause of their problems.

Patients taking the questionnaire are asked questions regarding their likelihood of falling asleep during eight normal, low activity situations. Patients rate their likelihood of dozing off on a scale of 0-3, with 0 being “no chance of dozing” and 3 being “high chance of dozing.”

Likelihood of having a sleep disorder is ranked on a scale of 0-24 after all questions have been answered, and the total points of “chances of dozing” are added to produce a single number.

• 0-7: Unlikely that patient is abnormally sleepy
• 8-9: Patient has an average amount of daytime sleepiness
• 10-15: Patient may be excessively sleepy depending on the situation. Patient may want to consider seeking medical treatment
• 16-24: Patient is excessively sleepy and should consider seeking medical attention.

The reason the ESS has become the standard assessment tool for symptoms of sleepiness is because it is a very quick questionnaire to complete and it gives a generalized level of a person’s average sleepiness.

What does the Epworth Sleepiness Scale tell us?

The questions ask “how likely” one is to doze in key situations rather than “how often” because many people may not find themselves in those particular situations everyday. Rather, the idea is to get a relative indicator of how sleepy someone is comparative to a normal waking day.

There are many factors that may cause a person to be excessively sleepy all the time, and the ESS does not aim to distinguish what those factors may be, but rather distinguishes that excessive sleepiness may be a health concern that warrants further diagnosis.

The ESS is not a diagnostic tool in itself. It is an assessment tool that physicians and sleep medicine professionals use to determine whether a patient should schedule a sleep study to diagnose, or rule out sleep disorders that may be affecting their everyday sleep.

The ESS is used primarily to validate symptoms of sleep apnea, narcolepsy, and idiopathic hypersomnia. All of which list excessive daytime sleepiness as a primary symptom.

What to do after taking the Epworth Sleepiness Scale assessment

Depending on the score you received from taking the test will help determine if seeking further medical treatment for a sleep disorder is warranted. The test should be administered by a physician or sleep professional and the results should be withheld until the end of the test.

The ESS does not indicate a sleep debt, presence of a sleep disorder, nor how much a person sleeps during the day. It only measures a person’s average sleep propensity (ASP), which can often be an indicator of a sleep disorder.

Sleep clinics will often ask a variety of other questions that will help determine the likelihood of a sleep disorder and the necessity for a sleep study.

Here is a list of questions that the Alaska Sleep Clinic asks during its screening process:

• Do you snore or have been told that you snore?
• Have you ever been told you stop breathing or gasp in your sleep?
• Do you feel sleepy during the daytime?
• Do you have asthma, emphysema, or other breathing problems?
• Do you have high blood pressure or take medicine for that reason?
• Have you ever had heart problems or heart disease?Have you ever had a stroke or “warning stroke?”
  • If Yes: have you been told that you have congestive heart failure?
• Do you feel like your sleep is “restful” such that you feel restored in the morning?
• Do you have difficulty focusing or concentrating in the daytime?
• Does leg restlessness keep you awake?
• Do you have insomnia?
• What is your height & weight?

These types of questions are helpful in assessing the likelihood of sleep apnea and a few other sleep disorders such as restless leg syndrome (RLS). Some of these questions target other health concerns such as stroke, heart disease, and breathing problems that often are associated with untreated sleep apnea.

If you feel that your excessive daytime sleepiness is a cause for concern and you would like to discuss the possibility of a sleep study, contact your primary care physician and discuss your symptoms with them. You can also contact a sleep specialist to setup a sleep consultation by reaching out to your local sleep clinic.

If you live in Alaska and would like to schedule a consultation or speak with a sleep specialist about your sleep health click the link below to receive a free 10-minute phone consultation with one of our sleep educators.