Understanding the Epworth Sleepiness Scale: What Your Daytime Sleepiness Score Means

Feeling tired during the day is common — but excessive daytime sleepiness is not normal.

The Epworth Sleepiness Scale (ESS) is a simple, clinically validated questionnaire used to measure how likely you are to fall asleep in everyday situations.

It is widely used in sleep clinics and primary care to assess for conditions such as:

• Obstructive sleep apnoea
• Narcolepsy
• Insomnia-related sleep deprivation
• Other sleep disorders

In this guide, we explain how the Epworth Sleepiness Scale works, how it is scored, and what your result means.

What Is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale is a short self-administered questionnaire developed by Dr Murray Johns in 1991.

It measures daytime sleepiness, not fatigue.

You are asked to rate your likelihood of dozing off in eight common daily situations.

Each situation is scored from:

• 0Would never doze
• 1Slight chance of dozing
• 2Moderate chance of dozing
• 3High chance of dozing

The total score ranges from 0 to 24.

The 8 Situations Assessed in the Epworth Scale

You are asked how likely you are to fall asleep in the following situations:

These scenarios help assess your general level of sleepiness.

How Is the Epworth Sleepiness Scale Scored?

Add together your scores for all eight questions.

Score Interpretation

A score of 11 or higher may indicate a sleep disorder and warrants further evaluation.

Why Is the Epworth Sleepiness Scale Important?

Excessive daytime sleepiness is not just inconvenient — it can be a warning sign.

It may indicate:

• Obstructive sleep apnoea
• Poor oxygen levels during sleep
• Fragmented sleep architecture
• Chronic sleep deprivation
• Underlying neurological sleep disorders

High sleepiness scores are also associated with:

• Increased accident risk
• Reduced concentration and productivity
• Cardiovascular risk
• Mood disturbances

Epworth vs STOP-Bang: What's the Difference?

While both are screening tools, they measure different things.

Used together, they provide a clearer picture of sleep health.

When Should You Consider Completing the Epworth Scale?

You should consider screening if you:

• Feel tired despite 7–8 hours in bed
• Struggle to stay awake during meetings or reading
• Doze unintentionally during the day
• Experience morning headaches
• Have loud snoring
• Have high blood pressure

Daytime sleepiness is often overlooked — but it is one of the strongest indicators of underlying sleep disorders.

Limitations of the Epworth Sleepiness Scale

While widely used, the Epworth Scale:

• Is subjective (self-reported)
• Does not diagnose sleep apnoea
• Does not measure oxygen levels
• Does not replace a clinical sleep assessment

It is a screening tool — not a diagnostic test.

What Happens If Your Score Is High?

If your Epworth score is elevated, further evaluation may include:

• Structured sleep assessment
• STOP-Bang screening
• Home sleep testing
• Clinical consultation

Early identification of sleep disorders can significantly improve energy levels, cardiovascular health, and overall wellbeing.

Take the Next Step

If you regularly feel sleepy during the day, your body may be signalling an underlying issue. A structured sleep screening assessment can help determine your risk and guide appropriate next steps.

References

1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545. https://pubmed.ncbi.nlm.nih.gov/1798888/
2. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376-381. https://pubmed.ncbi.nlm.nih.gov/1519015/
3. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014. https://aasm.org
4. National Heart, Lung, and Blood Institute (NHLBI). Sleep Apnea — Symptoms and Diagnosis. https://www.nhlbi.nih.gov/health/sleep-apnea