Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations?
Q1. Sitting and reading
Q2. Watching TV
Q3. Sitting inactive in a public place (e.g. theatre or meeting)
Q4. As a passenger in a car for an hour without a break
Q5. Lying down to rest in the afternoon when circumstances permit
Q6. Sitting and talking to someone
Q7. Sitting quietly after lunch without alcohol
Q8. In a car, while stopped for a few minutes in traffic
0/8 questions answered
Hva er Epworth Sleepiness Scale?
▾
The Epworth Sleepiness Scale (ESS) is a validated, self-administered questionnaire developed by Dr Murray Johns at the Epworth Hospital in Melbourne, Australia, and first published in 1991. It is the most widely used tool for measuring daytime sleepiness in clinical practice and research worldwide. Unlike subjective global sleepiness ratings, the ESS asks respondents to rate their likelihood of dozing or falling asleep in eight specific real-world situations — capturing habitual somnolence rather than momentary fatigue. The eight situations assessed span a range from highly somnolent (e.g., lying down to rest in the afternoon when circumstances permit) to least somnolent (e.g., sitting and reading). Each situation is rated on a 4-point scale: 0 (would never doze), 1 (slight chance of dozing), 2 (moderate chance), 3 (high chance). The total ESS score ranges from 0 to 24; a score of >10 indicates excessive daytime sleepiness (EDS), warranting clinical evaluation. A score of 11–15 indicates moderate EDS; 16–24 indicates severe EDS. The ESS correlates with objective sleep measures such as the Multiple Sleep Latency Test (MSLT) and is widely used in the diagnosis and monitoring of sleep disorders including obstructive sleep apnoea (OSA), narcolepsy, idiopathic hypersomnia, insufficient sleep syndrome, and the sleepiness-related effects of medications. It is the standard screening tool in sleep medicine clinics globally and is recommended by the American Academy of Sleep Medicine (AASM), the British Thoracic Society (BTS), and the European Respiratory Society (ERS) for OSA assessment and monitoring treatment response with CPAP therapy.
DigiCalcs delivers precision-engineered tools for engineers and STEM professionals.
Formel
▾
ESS Score = Sum of 8 situation scores (each 0–3); Total range 0–24; Interpretation: 0–10 = Normal range (no excessive daytime sleepiness); 11–12 = Mild EDS (marginal); 13–15 = Moderate EDS; 16–24 = Severe EDS; Each situation scored: 0 = would never doze; 1 = slight chance; 2 = moderate chance; 3 = high chance of dozingVariabelbeskrivelse
▾
| Symbol | Navn | Enhet | Beskrivelse |
|---|---|---|---|
| ESS | Epworth Sleepiness Scale-poengsum | 0–24 | Total poengsum fra 8 situasjonsbetingede vurderinger; >10 = overdreven søvnighet på dagtid |
| EDS | Overdreven søvnighet på dagtid | yes/no | Patologisk tilbøyelighet til å sovne i upassende situasjoner i våkne timer; definert som ESS >10 |
| AHI | Apné-Hypopne-indeks | events/hour | OSA-alvorlighetsindeks: <5 normal; 5–14 mild; 15–29 moderat; ≥30 alvorlig OSA |
| MSLT | Multiple Sleep Latency Test | minutes | Objektivt mål på søvnighet; gjennomsnittlig søvnlatens <8 min = unormal; <5 min = narkolepsiområde |
| CPAP | Kontinuerlig positivt luftveistrykk | cmH₂O | Førstelinje OSA-behandling; typisk 8–14 cmH2O; tilstrekkelig etterlevelse ≥4t/natt ≥5 netter/uke |
Slik Epworth Sleepiness Scale
▾
- 1Provide the patient with the 8-situation ESS questionnaire and instruct them to rate the likelihood of dozing (not just feeling tired) in each situation based on their recent usual way of life.
- 2Situation 1: Sitting and reading (reading a book, newspaper, magazine, or document) — one of the most somnolent situations for people with EDS.
- 3Situation 2: Watching TV — sedentary, passive visual stimulus that readily induces drowsiness in the sleep-deprived.
- 4Situation 3: Sitting inactive in a public place (e.g., theatre, meeting, or lecture) — social inhibition usually suppresses dozing; high scores in this situation indicate severe EDS.
- 5Situation 4: As a passenger in a car for an hour without a break — monotonous passive travel is highly somnolent; scoring ≥2 in this situation carries road safety implications.
- 6Situation 5: Lying down to rest in the afternoon when circumstances permit — the most somnolent situation; high scores here are nearly universal in significant EDS.
- 7Situation 6: Sitting and talking to someone — a social interaction that suppresses sleep; dozing while talking to someone is a significant indicator of severe EDS.
- 8Situation 7: Sitting quietly after lunch without alcohol — post-prandial somnolence is physiologically normal; moderate scores common in mild EDS.
- 9Sum all 8 situation scores to get the total ESS score; interpret against clinical context; if ESS >10, initiate sleep disorder evaluation including history, BMI, STOP-BANG questionnaire for OSA, referral for polysomnography or home sleep testing as appropriate.
Løste eksempler
▾
A score of 7 is within the population normal range; sleep quantity and quality appear adequate based on this assessment.
The majority of healthy adults without sleep disorders score 5–9 on the ESS; scores of 0 are uncommon and may indicate under-reporting.
An ESS of 16 combined with STOP-BANG ≥5 and obesity has a high positive predictive value for moderate-to-severe OSA.
In this clinical context, ESS confirms subjective EDS and supports urgent sleep study referral; OSA is the most likely diagnosis and CPAP treatment should be anticipated.
ESS improvement ≥3 points with CPAP is considered a clinically meaningful response; normalisation to <10 indicates optimal symptom control.
The ESS is the standard instrument for monitoring CPAP treatment response; a score returning to the normal range (≤10) while maintaining CPAP adherence ≥4h/night indicates effective OSA management.
ESS >15 in a young patient with the tetrad of EDS, cataplexy, sleep paralysis, and hypnagogic hallucinations is virtually diagnostic of narcolepsy type 1.
Narcolepsy produces the highest ESS scores in clinical practice (typically 15–24); confirmatory testing requires MSLT with ≥2 sleep-onset REM periods (SOREMPs) and/or CSF hypocretin-1 <110 pg/mL.
Praktiske anvendelser
▾
Småbedriftseiere bruker Epworth Sleepiness til å evaluere prisbeslutninger, bestemme break-even-punkter for nye produktlinjer og beregne margineffekten av volumrabatter som tilbys grossistkjøpere og langsiktige kontraktskunder.
Økonomikontrollører i mellomstore bedrifter bruker Epworth Sleepiness i månedlig ledelsesrapportering for å spore lønnsomhetstrender, beregne avvik i forhold til budsjett og identifisere kostnadskategorier der forbedringer av operasjonell effektivitet vil ha størst innvirkning på ytelsen på bunnlinjen.
Startup-gründere bruker Epworth Sleepiness når de bygger finansielle modeller for investorpresentasjoner, projiserer rullebane basert på gjeldende forbrenningshastighet og beregner inntektsveksten som er nødvendig for å oppnå lønnsomhet før neste finansieringsrunde.
Ledelseskonsulenter er avhengige av Epworth Sleepiness for å måle kunders ytelse mot bransjekolleger, kvantifisere den økonomiske effekten av foreslåtte operasjonelle forbedringer og bygge forretningscases som rettferdiggjør beslutninger om kapitalinvesteringer overfor ledere.
Spesielle tilfeller
▾
Ekstreme inngangsverdier
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in epworth sleepiness calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
Forutsetningsbrudd
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in epworth sleepiness calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
Avrunding og presisjonseffekter
In practice, this edge case requires careful consideration because standard assumptions may not hold. When encountering this scenario in epworth sleepiness calculations, practitioners should verify boundary conditions, check for division-by-zero risks, and consider whether the model's assumptions remain valid under these extreme conditions.
ESS og graviditet
Graviditet er assosiert med økt subjektiv søvnighet, spesielt i første og tredje trimester, og ESS-skår er forhøyet i gjennomsnitt sammenlignet med ikke-gravide kontroller. OSA er mer utbredt under graviditet (spesielt hos kvinner med fedme eller svangerskapsforgiftning) og medfører risiko for mors- og fosterutfall. ESS-screening i svangerskapsklinikker kan identifisere kvinner som krever henvisning til søvnstudier.
Epworth Sleepiness reference data
▾
| ESS Score | Tolkning | Klinisk handling |
|---|---|---|
| 0–10 | Normal — no excessive daytime sleepiness | Reassure; address sleep hygiene if borderline |
| 11–12 | Mild EDS — borderline | Clinical review; sleep history; lifestyle advice; repeat ESS |
| 13–15 | Moderate EDS | Sleep disorder evaluation; STOP-BANG; consider sleep study referral |
| 16–24 | Severe EDS | Urgent sleep study; driving safety assessment; restrict from safety-critical work if indicated |
| ≥16 + OSA confirmed | Severe OSA-related EDS | Urgent CPAP initiation; 4-week follow-up with repeat ESS |
| ESS reduction ≥3 on CPAP | Clinically meaningful treatment response | Continue CPAP; reassess annually |
Ofte stilte spørsmål
▾
What is excessive daytime sleepiness?
Excessive daytime sleepiness (EDS) is the tendency to fall asleep unintentionally or to fall asleep in inappropriate situations during normal waking hours. It is distinct from fatigue (physical or mental tiredness without an increased drive to sleep). EDS affects approximately 10–15% of the adult population and is most commonly caused by obstructive sleep apnoea, insufficient sleep, idiopathic hypersomnia, narcolepsy, medication side effects, or circadian rhythm disorders.
Is the ESS reliable across different languages and cultures?
The ESS has been translated and validated in over 50 languages with good reliability coefficients (Cronbach's alpha typically 0.73–0.88). However, cultural differences in sleepiness norms and reporting tendencies may affect population-level scores; normal reference ranges may need adjustment for different cultural contexts. ESS reliability is higher in clinical populations than in community surveys.
Can the ESS detect all causes of excessive daytime sleepiness?
The ESS measures subjective sleepiness but cannot identify its cause. It is a screening tool that indicates severity of EDS rather than diagnosis. An ESS >10 should trigger clinical evaluation including sleep history, medication review, questionnaires for OSA (STOP-BANG), and formal sleep studies (polysomnography or home sleep testing) to identify the underlying sleep disorder.
What ESS score is required for CPAP therapy funding in the UK?
NHS funding criteria for CPAP vary by region, but NICE CG173 (2014) recommends CPAP for adults with moderate-to-severe OSA (AHI ≥15/h) or for mild OSA (AHI 5–14/h) when ESS >9 or there are other relevant comorbidities (cardiovascular risk, occupational sleepiness). An ESS >10 combined with confirmed OSA on sleep study is the typical threshold for treatment initiation.
What is the MSLT and how does it relate to the ESS?
The Multiple Sleep Latency Test (MSLT) is an objective measurement of daytime sleepiness conducted in a sleep laboratory. The patient undergoes 4–5 nap opportunities across the day; sleep latency is measured for each nap. Mean sleep latency <8 minutes indicates abnormal sleepiness; <5 minutes is severe. The MSLT is the gold-standard objective measure for narcolepsy diagnosis (requires ≥2 SOREMPs) and correlates moderately with the ESS — they measure related but distinct aspects of sleepiness.
Does the ESS change with age?
ESS scores tend to be slightly lower in older adults compared to young and middle-aged adults — partly because older adults may have adapted their lifestyle to avoid somnolent situations or may have reduced awareness of sleepiness. Reference ranges for the ESS are based predominantly on adult populations aged 20–60; interpretation should be contextualised in elderly patients where lower absolute scores may still represent clinically meaningful sleepiness.
Is the ESS suitable for use in children?
The ESS was developed for adults. A paediatric version (PDSS — Paediatric Daytime Sleepiness Scale) was developed for children. However, the ESS can be administered to adolescents (≥12 years) with good reliability. For younger children, parent-reported sleepiness measures (CSHQ — Children's Sleep Habits Questionnaire) are preferred. Sleepiness in school-age children is more commonly manifested as hyperactivity and inattention than as overt dozing.
Vanlige feil å unngå
▾
- !Forvirrende tretthet (tretthet uten søvndrift) med søvnighet (økt tilbøyelighet til å sovne) — ESS måler spesifikt søvnighet; tretthet måles bedre med verktøy som FACIT-F-skalaen.
- !Bruk av ESS som en diagnostisk test i stedet for et screening- og overvåkingsverktøy - ESS >10 indikerer at ytterligere evaluering er nødvendig, ikke at en spesifikk diagnose er bekreftet.
- !Å ikke gjenta ESS etter CPAP-start for å vurdere behandlingsrespons - en engangsmåling gir ingen informasjon om forbedring.
- !Å akseptere lave ESS-score hos åpenbare OSA-pasienter som betryggende - noen pasienter med alvorlig OSA rapporterer lav ESS fordi de har tilpasset livsstilen sin for å unngå søvnige situasjoner eller er dårlige rapporter om sin egen søvnighet.
- !Ikke vurdere medisinbivirkninger som en årsak til forhøyet ESS - ta alltid en omfattende medisinhistorie før du tilskriver høy ESS til en primær søvnforstyrrelse.
- !Overse kjøresikkerhetsrådgivning for pasienter med ESS ≥15 — dette er en medisinsk og medisinsk juridisk forpliktelse i de fleste jurisdiksjoner.
Pro Tips
Når en pasients CPAP-overholdelsesdata viser god overholdelse (≥4t/natt), men ESS forblir >10, må du ikke anta behandlingssvikt. Vurder: (1) gjenværende AHI på CPAP (lekkasje, posisjonelle apnéer); (2) en sameksisterende søvnforstyrrelse (narkolepsi, idiopatisk hypersomni, rastløse ben, periodisk bevegelsesforstyrrelse i lemmer); (3) medisiner som forårsaker EDS; (4) komorbid depresjon. En gjentatt polysomnografi med CPAP er garantert.
Visste du?
Dr. Murray Johns kalte Epworth Sleepiness Scale etter Epworth Hospital i Melbourne hvor han jobbet - ikke en historisk person kalt Epworth. I 1991, da skalaen ble publisert, ble Johns nyskapende idé om å spørre om situasjonsbestemt døsing i stedet for bare global tretthet ansett som ny. Skalaen administreres nå omtrent 10 millioner ganger årlig over hele verden i søvnklinikker og forskningsstudier.
Regional Guides
▾
🇺🇸 US▾
🇬🇧 UK▾
🇪🇺 EU▾
Referanser
- ›Johns MW - En ny metode for å måle søvnighet på dagtid: Epworth Sleepiness Scale (Sleep, 1991)
- ›Epworth Sleepiness Scale - Dr Murray Johns
- ›NICE CG173 — Kontinuerlig positivt luftveistrykk for behandling av obstruktiv søvnapné/hypopnésyndrom (2014)
- ›AASM — Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea (2017)
- ›BTS-retningslinje – Søvnapné og hypopnésyndrom hos voksne (2019)
Få ukentlige mattetips
Bli med 12 000+-abonnenter som får kalkulatortips hver uke.