Unlock Your Energy Potential: The Complete Guide to the (ESS) Epworth Sleepiness Scale
- scotteckett
- Mar 17
- 9 min read
What is the Epworth Sleepiness Scale?
The Epworth Sleepiness Scale (ESS) is a clinically validated questionnaire developed in 1991 by Australian researcher Dr. Murray Johns. It measures daytime sleepiness by assessing your likelihood of dozing off during eight common scenarios, such as reading, watching TV, or sitting in traffic. Scores range from 0 (no sleepiness) to 24 (severe sleepiness).
Why Use the Epworth Sleepiness Scale?
Excessive daytime sleepiness (EDS) affects 10–20% of adults globally, increasing risks of accidents, reduced productivity, and chronic health issues. The Epworth Sleepiness Scale helps:
Screen for sleep disorders like obstructive sleep apnoea (OSA) and narcolepsy.
Track improvements from treatments (e.g., CPAP therapy).
Raise awareness about sleep health (American Academy of Sleep Medicine).
How to Calculate Your Epworth Sleepiness Scale Score
Step 1: Rate Eight Scenarios For each activity, score your likelihood of dozing:
0: Would never doze
1: Slight chance
2: Moderate chance
3: High chance
Scenario | Your Score |
Sitting and reading | |
Watching TV | |
Sitting in a public place | |
Riding as a car passenger | |
Lying down in the afternoon | |
Sitting and talking to someone | |
Sitting quietly after lunch | |
Stopped in traffic |
Step 2: Add Your Scores Total = Sum of all eight scenario scores.
Example Calculation: If your total is 18-24, this suggests severe daytime sleepiness (see interpretation below).
What is a Good score on the Epworth Sleepiness Scale?
The standard clinical interpretation is:
ESS Score | Interpretation | Next Steps |
0–10 | Normal Range | Maintain healthy sleep habits. |
11–14 | Mild Sleepiness | Improve sleep hygiene; track with a sleep diary. Consider a sleep study if symptoms persist. |
15–17 | Moderate Sleepiness | Consult a doctor to rule out sleep apnoea or other disorders. |
18–24 | Severe Sleepiness | Seek urgent medical evaluation for conditions like narcolepsy or severe OSA. |
Key Insights:
11–14 (Mild Sleepiness):
"Associated with increased accident risk in safety-critical roles."
Source: Studies show Epworth Sleepiness Scale scores ≥11 correlate with higher accident rates in professions like truck driving (Powell et al., 2002).
Context: Fatigue from untreated sleepiness can impair reaction times and decision-making.
15–17 (Moderate Sleepiness):
"May indicate moderate-to-severe obstructive sleep apnoea (OSA)."
Source: Epworth Sleepiness Scale scores ≥10 are used to screen for OSA, but severity is confirmed via sleep studies (AASM Guidelines).
Context: OSA severity is measured by the Apnoea-Hypopnoea Index (AHI), not ESS scores.
18–24 (Severe Sleepiness):
"Common in narcolepsy or idiopathic hypersomnia, but requires clinical confirmation."
Source: Epworth Sleepiness Scale scores ≥14 are frequent in central hypersomnia's (Trotti et al., 2019).
Context: A sleep study (polysomnography) is mandatory for diagnosis.
"The Epworth Sleepiness Scale (ESS) is a screening tool, not a diagnostic test. Always consult a sleep specialist for interpretation of scores and next steps."
Is the Epworth Sleepiness Scale Reliable?
The Epworth Sleepiness Scale is a well-validated screening tool with high test-retest reliability (0.82) (Johns, 1991). It detects moderate-to-severe sleep apnoea with 70–80% sensitivity and distinguishes narcolepsy from normal sleepers with 94–98% specificity (Johns, 1999). However, it is not diagnostic, abnormal scores require confirmation via sleep studies. Cultural bias (e.g., car-centric scenarios) and subjective scoring also limit utility in some populations.
Scientific Validity
Test-Retest Reliability: 0.82 (Johns, 1991)
Correct: The original ESS validation study (Johns, 1991) reports a test-retest reliability coefficient of 0.82, indicating high consistency.
Source: A scale measure of sleepiness was developed and validated in two studies... The test-retest reliability coefficient was 0.82.
Sensitivity for Sleep Apnoea: ~75%
Correct: Studies like Chung et al. (2008) show ESS sensitivity for moderate-to-severe OSA ranges from 70–80% when combined with clinical evaluation.
Clarification: Sensitivity varies by study population (e.g., higher in clinic-based vs. community samples).
Specificity for Narcolepsy: 94–98% (Johns, 1999)
Correct: Johns’ follow-up work (1999) found ESS scores ≥14 distinguish narcolepsy from normal sleepers with 94–98% specificity.
Source: ESS scores ≥14 had a specificity of 94% for diagnosing narcolepsy.
Limitations
Not a Diagnostic Tool
Correct: The Epworth Sleepiness Scale is explicitly a screening tool per the AASM. Polysomnography or MSLT is required for diagnosis.
Cultural Bias
Correct: The Epworth Sleepiness Scale's Western-centric scenarios (e.g., driving) limit its global applicability. Studies like Chen et al. (2015) validate this critique.
Subjective Scoring
Correct: Self-reported Epworth Sleepiness Scale scores can diverge from objective measures like the Multiple Sleep Latency Test (MSLT).
How Accurate is the Epworth Sleepiness Scale?
The Epworth Sleepiness Scale is a validated screening tool for daytime sleepiness, but its accuracy depends on the disorder:
Sensitivity: Detects ~75% of moderate-to-severe obstructive sleep apnoea cases when combined with symptoms like snoring (Chung et al., 2008).
Specificity: Distinguishes narcolepsy from normal sleepers with 94–98% accuracy (Johns, 1999).
For reliable results, pair the ESS with:
Sleep Studies (Polysomnography): Measures brain waves, breathing, and oxygen levels to diagnose disorders like sleep apnoea or narcolepsy.
Actigraphy: Tracks sleep-wake patterns via wearable devices.
Sleep Diaries: Logs lifestyle factors (e.g., caffeine, stress, bedtime routines).
Pro Tip: Retake the ESS every 4–6 weeks if managing a sleep disorder (e.g., during CPAP therapy) to track improvements.
5 Hidden Factors Affecting Your Epworth Sleepiness Scale Score
1. Circadian Rhythm Disruptions
Shift work or jet lag can raise ESS scores by 2–4 points due to misaligned sleep-wake cycles. (Drake et al., 2004).
2. Medication Side Effects
Antidepressants and antihistamines often cause drowsiness. (Pagel et al., 2008).
3. Iron Deficiency Anaemia
Iron deficiency anaemia can worsen fatigue and elevate ESS scores by causing restless legs syndrome (RLS) or reducing oxygen delivery. (Allen et al., 2018).
4. Mental Health
Depression is associated with higher ESS scores (3–5 points on average) due to fatigue and disrupted sleep architecture. (Roehrs et al., 2000).
5. Sleep Environment
Noise, light, or poor bedding disrupt restorative sleep, elevating ESS scores. Optimizing your sleep environment (e.g., blackout curtains, white noise machines) can improve sleep quality. (Halperin, 2014).
Optimise your setup with tips from our blog, following the latest research, can help improve your rest. offers insights on how to determine the best practices for your sleep condition.
How to Improve Your ESS Score: 7 Science-Backed Strategies
1. Prioritise Sleep Hygiene
Fix Your Schedule: Use our Sleep Calculator to align with your chronotype.
Wind Down Ritual: A 60-minute wind-down routine, such as reading (avoiding screens), meditation, or light stretching, can signal to your body that it’s time to sleep. These activities reduce stress and physical tension, aligning with your circadian rhythm. Adjust the duration based on personal needs, but aim for at least 30 minutes of calming activities before bed.
Reading: (physical books or non-backlit e-readers) reduces stress and distracts from daytime worries, improving sleep onset (University of Sussex Study, 2009).
Meditation: Mindfulness or deep-breathing practices lower heart rate and anxiety, priming the body for sleep (Harvard Medical School)
Light Stretching: Gentle yoga or stretching reduces muscle tension and improves sleep quality, especially in people with insomnia (National Centre for Complementary and Integrative Health).
2. Optimise Your Bedroom
Temperature: Aim for a bedroom temperature of 16–18°C (60–65°F), which aligns with the body’s natural cooling process during sleep. Adjust based on personal comfort and bedding. National Sleep Foundation. (2023). Best Temperature for Sleep.
Light exposure can significantly affect your ability to fall asleep: Minimize evening light exposure (especially from screens) to avoid suppressing melatonin. Use blackout curtains or a sleep mask to create a dark sleep environment. Harvard Medical School. (2020). Blue Light and Sleep. Journal of Clinical Sleep Medicine. (2017). Light Exposure and Sleep.
3. Exercise Smartly
Morning Workouts: Morning cardio workouts, even as short as 20 minutes, may boost daytime alertness by stimulating endorphins and aligning with natural circadian rhythms. (National Sleep Foundation: Exercise and Sleep).
Avoid PM Intensity: Intense evening workouts may delay sleep onset in some people due to elevated adrenaline or body temperature. However, moderate evening exercise is generally safe and may even improve sleep quality. Journal of Clinical Sleep Medicine: Evening Exercise and Sleep.
4. Nutrition Tweaks
Magnesium: Prioritise magnesium-rich foods as part of a balanced diet, but don’t expect them to cure chronic insomnia alone. National Institutes of Health: Magnesium Fact Sheet.
Late Carbs: Focus on type and quantity of the carbohydrates, avoid large, high-sugar meals close to bedtime. American Journal of Clinical Nutrition: Carbs and Sleep.
5. Manage Stress
4-7-8 breathing technique: (inhale 4s, hold 7s, exhale 8s) is a popular relaxation method that leverages slow breathing to reduce stress. While individual results may vary, paced breathing is broadly supported by research for calming the nervous system. Frontiers in Human Neuroscience (2018): Slow Breathing and Autonomic Function.
Progressive Muscle Relaxation: (PMR), tensing and releasing muscle groups, can reduce tension in as little as 10 minutes, particularly for those familiar with the practice. Research supports its effectiveness for stress relief, though benefits may improve with regular use. Applied Psychophysiology and Biofeedback (2005): Abbreviated PMR Protocols.
6. Limit Stimulants
Avoid caffeine: At least 6–8 hours before bedtime. For a 10 PM bedtime, this means cutting off by 2–4 PM. Adjust based on your sleep schedule and sensitivity. Most experts recommend avoiding caffeine 6–8 hours before bedtime (Sleep Foundation).
Alcohol: disrupts REM sleep and causes fragmented sleep, worsening fatigue. Avoid it within 3–4 hours of bedtime for better sleep quality. (NIH Study).
7. Seek Professional Support
Scores of 15 or higher suggest significant sleepiness that may require medical attention. Consult a sleep specialist to rule out conditions like sleep apnoea or narcolepsy. Evidence-based online programs (e.g., CBT-I) can support treatment but are not a substitute for professional diagnosis. For sleep recovery coaching click here.
ESS FAQs: Your Top Questions Answered
Q: Can children use the ESS?
A: No, the Epworth Sleepiness Scale (ESS) is validated for ages 16 and older. For children under 16, use tools specifically designed for younger populations, such as:
Paediatric Sleep Questionnaire (PSQ): Focuses on sleep-disordered breathing (e.g., snoring, apnoea).
Paediatric Daytime Sleepiness Scale (PDSS): Assesses daytime sleepiness in school-aged children and adolescents.
Always consult a paediatric sleep specialist to choose the most appropriate tool for your child’s age and symptoms.
Q: Does the ESS work for night shift workers?
A: The Epworth Sleepiness Scale can be used for night shift workers, but its results require careful interpretation. Scores may reflect circadian rhythm disruption (e.g., fatigue from working nights) rather than an underlying sleep disorder. For example, a high ESS score in a shift worker could stem from misaligned sleep-wake cycles rather than conditions like sleep apnoea.
For accurate assessment:
Pair the ESS with tools designed for shift workers, such as the Karolinska Sleepiness Scale (measures acute sleepiness).
Consult a sleep specialist familiar with shift work disorder to contextualise results.
Q: How often should I retake the ESS?
A: If managing a sleep disorder, retake the assessment every 4–6 weeks to monitor changes in symptoms and treatment effectiveness. This interval allows sufficient time for interventions (e.g., CPAP therapy, medication adjustments) to take effect while avoiding over-assessment.
Key considerations:
Follow your clinician’s advice, as retesting frequency may vary based on your specific condition and treatment plan.
Pair ESS results with objective measures (e.g., sleep diaries, actigraphy) for a comprehensive evaluation
When to See a Doctor?
Consult a sleep specialist if:
Your ESS score is ≥15, which suggests severe daytime sleepiness often linked to disorders like sleep apnoea or narcolepsy.
You snore loudly or gasp during sleep, as these are key symptoms of obstructive sleep apnoea (OSA).
Fatigue persists despite 7+ hours of sleep, which may indicate poor sleep quality or an undiagnosed condition.
Pro Tip: Bring a two-week sleep diary to your appointment, noting:
Bedtimes and wake times.
Nighttime awakenings.
Caffeine/alcohol intake.
Daytime naps.
This helps your doctor identify patterns and tailor treatment.
Conclusion: Take Charge of Your Sleep Health
Overview: The Epworth Sleepiness Scale is a validated tool to identify trouble staying awake during daily activities.
Whether your score is low or high, it helps determine whether your daytime sleepiness affects tasks like driving or working, or suggests the need to investigate underlying health conditions, If your Epworth sleepiness scale results are a cause for concern (e.g., you rank in the moderate-to-severe range), it’s time to contact your GP to discuss the results and follow-up next steps.
For instance, if you’ve done some of these things, like struggling to stay alert during meetings or while driving, your score might reflect a need for additional testing.
Test details, such as the eight scenarios in the assessment, help pinpoint specific triggers. Share your results and discuss them with a specialist, who may recommend a sleep study to rule out disorders.
Even small tweaks to your way of life, like using our sleep calculator or maintaining a sleep diary, can lead to long-term improvements. Sometimes, fatigue stems from certain habits (e.g., irregular bedtimes) rather than a medical issue. However, if symptoms persist, try optimising your sleep hygiene or ask about CPAP therapy for severe cases.
Remember: A high score doesn’t always mean a disorder, but it’s a sample indicator worth exploring. By addressing these factors, you’ll reclaim energy, reduce risks linked to untreated sleep issues and improve your way of life.
For Insights and more: Explore our Sleep Blog for guides on circadian rhythms, and science-backed strategies.
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