The Epworth Sleepiness Scale (ESS): What Is It and How Does It Work?

Last updated: September 25th, 2023

What Is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale (ESS) is an 8-question survey used as a tool to detect excessive daytime sleepiness (EDS). It was developed in 1990 and has been validated as an accurate measure of sleep alertness Trusted Source National Sleep Foundation The National Sleep Foundation is dedicated to improving sleep health and safety through education, public awareness, and advocacy. View Source . The ESS is commonly distributed to patients as part of a sleep study in order to assess the severity of sleepiness and possible causes for it. Each of the 8 questions looks at the likelihood that the individual will doze off during a variety of common circumstances.

What Is Excessive Daytime Sleepiness?

Excessive daytime sleepiness (EDS) is a commonly recognized disorder characterized by an excessive feeling of sleepiness that occurs during the day and affects one’s alertness and ability to stay awake. EDS can be caused by a variety of different factors, including sleep deprivation and circadian rhythm disorders. It can also be a symptom of other medical conditions such as narcolepsy or obstructive sleep apnea Trusted Source MedlinePlus MedlinePlus is the U.S. National Library of Medicine's one-stop shop for reliable, up-to-date, and authoritative health information. View Source .

How the Epworth Sleepiness Scale Identifies Excessive Sleepiness

The 8-question Epworth Sleepiness Scale survey is designed to assess the severity of a person’s daytime sleepiness over the past month. Each of the questions evaluates the likelihood that a person will doze off during different situations. The individual rates from 0 to 3 how likely they are to doze in each situation, with 0 being no chance of dozing and 3 being a high likelihood of dozing off.

How Does the Epworth Sleepiness Scale Work?

The ESS assesses a person’s daytime sleepiness by looking at the likelihood of dozing off in 8 different circumstances. The individual rates from 0 to 3 how likely they are to doze off in each situation, with 0 being no chance and 3 being a high chance of dozing off. Based on the individual’s responses, the ESS then assigns a score between 0 and 24. A score of 10 or higher is considered to be indicative of EDS Trusted Source International Journal of General Medicine International Journal of General Medicine is a peer-reviewed open access journal that publishes evidence-based research on all aspects of general medicine. View Source. It is important to note that the ESS is just one tool and that a medical consultation is necessary if excessive daytime sleepiness is suspected.

Limitations of the Epworth Sleepiness Scale

The ESS is a valuable tool for detecting EDS but it also has certain limitations. Firstly, the ESS only measures the level of sleepiness over the past month which may not be indicative of an individual’s underlying medical condition. Secondly, the score given by the ESS does not indicate the cause of the excessive sleepiness. For this, a medical evaluation is usually necessary. Finally, the ESS is subjective and may be skewed by factors such as anxiety or depression.

Can the Epworth Sleepiness Scale Be Used For Children and Adolescents?

Yes, the ESS can be used for children and adolescents but it is important to note that the questions may need to be modified for age-appropriate situations Gortmaker, S. et al., “Validation of the Pediatric Epworth Sleepiness Scale”, Pediatrics, 1996. View Source. Certain adaptations may be necessary depending on the age of the individual being assessed.

Other Types of Sleep Studies

The Epworth Sleepiness Scale is just one tool that can be used to assess sleepiness and collect information from individuals. There are also other types of sleep studies that can be used such as actigraphy, polysomnography, and multiple sleep latency testing. Polysomnography is the most comprehensive of these as it not only measures physical and mental activity during sleep but can also detect possible underlying medical issues. Multiple sleep latency testing is another type of sleep study that measures the latency (the time it takes to fall asleep) during nap opportunities.

In conclusion, the Epworth Sleepiness Scale is a useful tool for identifying excessive daytime sleepiness but it should not be used as the sole method for diagnosing sleep-related issues. Other forms of testing such as polysomnography and multiple sleep latency testing may be necessary to assess potential medical conditions related to the sleepiness reported on the ESS.

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