Epworth Sleepiness Scale Calculator

Assess your daytime sleepiness levels using the validated Epworth Sleepiness Scale questionnaire to identify potential sleep disorders.

The Epworth Sleepiness Scale is a widely-used questionnaire that measures your likelihood of falling asleep in different situations. Answer 8 questions to get your ESS score and understand your sleep health status.

ESS Examples

Click on any example to load it into the calculator.

Normal Sleepiness

Normal Sleepiness

A person with normal daytime sleepiness levels showing healthy sleep patterns.

Sitting and reading: 0

Watching TV: 1

Sitting inactive in public: 0

Car passenger: 1

Lying down afternoon: 0

Sitting and talking: 0

After lunch: 0

Car stopped in traffic: 0

Total Score: 2

Interpretation: Normal

Mild Excessive Sleepiness

Mild Excessive Sleepiness

An individual showing mild excessive daytime sleepiness requiring lifestyle adjustments.

Sitting and reading: 2

Watching TV: 2

Sitting inactive in public: 1

Car passenger: 2

Lying down afternoon: 1

Sitting and talking: 1

After lunch: 1

Car stopped in traffic: 1

Total Score: 11

Interpretation: Mild Excessive Sleepiness

Moderate Excessive Sleepiness

Moderate Excessive Sleepiness

A person with moderate excessive sleepiness needing medical evaluation.

Sitting and reading: 2

Watching TV: 3

Sitting inactive in public: 2

Car passenger: 3

Lying down afternoon: 2

Sitting and talking: 1

After lunch: 2

Car stopped in traffic: 2

Total Score: 17

Interpretation: Moderate Excessive Sleepiness

Severe Excessive Sleepiness

Severe Excessive Sleepiness

An individual with severe excessive sleepiness requiring immediate medical attention.

Sitting and reading: 3

Watching TV: 3

Sitting inactive in public: 3

Car passenger: 3

Lying down afternoon: 3

Sitting and talking: 2

After lunch: 3

Car stopped in traffic: 3

Total Score: 23

Interpretation: Severe Excessive Sleepiness

Other Titles
Understanding Epworth Sleepiness Scale: A Comprehensive Guide
Master the science of daytime sleepiness assessment using the Epworth Sleepiness Scale. Learn how ESS scores relate to sleep health, sleep disorders, and when to seek medical attention.

What is the Epworth Sleepiness Scale (ESS)?

  • Definition and Purpose
  • Historical Development
  • Clinical Validation
The Epworth Sleepiness Scale (ESS) is a validated questionnaire designed to measure a person's general level of daytime sleepiness. Developed by Dr. Murray Johns at Epworth Hospital in Melbourne, Australia, in 1991, the ESS has become the gold standard for assessing excessive daytime sleepiness in clinical and research settings. The scale consists of eight questions that ask individuals to rate their likelihood of falling asleep in different situations, providing a quantitative measure of sleepiness that correlates with various sleep disorders and health conditions.
The Scientific Foundation of ESS
The ESS is based on the principle that excessive daytime sleepiness manifests in predictable situations where people typically remain awake. By assessing the likelihood of dozing in these specific scenarios, the scale provides an objective measure of sleepiness that can be compared across individuals and populations. The questionnaire has been extensively validated in numerous studies, showing strong correlations with objective measures of sleepiness such as the Multiple Sleep Latency Test (MSLT) and the Maintenance of Wakefulness Test (MWT). This scientific validation makes the ESS a reliable tool for both clinical assessment and research purposes.
ESS Scoring System and Interpretation
Each of the eight ESS questions is scored on a scale of 0 to 3: 0 = would never doze, 1 = slight chance of dozing, 2 = moderate chance of dozing, and 3 = high chance of dozing. The total score ranges from 0 to 24, with higher scores indicating greater daytime sleepiness. Clinical interpretation typically categorizes scores as follows: 0-10 = normal daytime sleepiness, 11-14 = mild excessive sleepiness, 15-17 = moderate excessive sleepiness, and 18-24 = severe excessive sleepiness. These categories help healthcare providers determine the need for further evaluation and treatment.
Global Clinical Applications and Standards
The ESS is used worldwide in sleep medicine clinics, primary care settings, and research studies to screen for sleep disorders and assess treatment effectiveness. It is particularly valuable for identifying conditions such as obstructive sleep apnea, narcolepsy, idiopathic hypersomnia, and other sleep-related breathing disorders. The scale's simplicity and reliability make it an essential tool in the diagnostic process, often serving as the first step in identifying patients who need comprehensive sleep evaluation.

ESS Score Categories and Clinical Significance:

  • ESS 0-10: Normal daytime sleepiness - no further evaluation typically needed
  • ESS 11-14: Mild excessive sleepiness - lifestyle modifications may be recommended
  • ESS 15-17: Moderate excessive sleepiness - medical evaluation recommended
  • ESS 18-24: Severe excessive sleepiness - immediate medical attention required

Step-by-Step Guide to Using the ESS Calculator

  • Question Interpretation
  • Scoring Methodology
  • Result Analysis and Action
Accurate ESS assessment requires honest self-reflection and understanding of the specific situations described in each question. Follow this comprehensive methodology to ensure your ESS score provides meaningful insights into your sleep health status.
1. Understanding Each ESS Question
The eight ESS questions assess sleepiness in different contexts: sedentary activities (reading, watching TV), social situations (talking to someone), transportation (car passenger), and rest periods (afternoon rest, after lunch). Each question asks about your usual behavior, not just when you're particularly tired. Consider your typical response to these situations over the past few months, not just recent experiences. Be honest about your likelihood of dozing, as this accuracy is crucial for proper assessment.
2. Accurate Scoring Methodology
Score each question based on your likelihood of dozing: 0 = would never doze (0% chance), 1 = slight chance of dozing (10-20% chance), 2 = moderate chance of dozing (30-50% chance), and 3 = high chance of dozing (60-80% chance). Don't consider situations where you would never be in that circumstance - focus on your likelihood if you were in that situation. Add all eight scores to get your total ESS score, which will range from 0 to 24.
3. Interpreting Your ESS Score
Your total ESS score falls into one of four categories that indicate your level of daytime sleepiness. A score of 0-10 suggests normal sleepiness levels, while scores of 11 or higher indicate excessive daytime sleepiness that may warrant medical attention. The higher your score, the more likely you are to have an underlying sleep disorder or health condition affecting your sleep quality. Consider your score in the context of other symptoms such as snoring, witnessed breathing pauses, or difficulty falling or staying asleep.
4. Taking Action Based on Results
If your ESS score is 11 or higher, consider consulting with a healthcare provider, particularly a sleep specialist. Scores of 15 or higher strongly suggest the need for medical evaluation. Even with normal scores, if you experience other sleep-related symptoms, medical consultation may still be appropriate. The ESS is a screening tool, not a diagnostic test, so professional evaluation is essential for accurate diagnosis and treatment of sleep disorders.

ESS Interpretation Guidelines:

  • ESS 0-5: Very low sleepiness - excellent sleep health
  • ESS 6-10: Normal sleepiness - typical for healthy individuals
  • ESS 11-14: Mild excessive sleepiness - consider lifestyle changes
  • ESS 15-17: Moderate excessive sleepiness - medical evaluation recommended
  • ESS 18-24: Severe excessive sleepiness - immediate medical attention needed

Real-World Applications and Sleep Health Implications

  • Clinical Practice and Diagnosis
  • Public Health and Safety
  • Personal Sleep Management
The ESS serves as a crucial tool across multiple healthcare domains, providing valuable insights for individual sleep health management, clinical decision-making, and public safety assessment.
Clinical Practice and Sleep Medicine
Sleep medicine specialists use the ESS as a standard screening tool during initial consultations to assess the severity of daytime sleepiness and guide diagnostic testing. ESS scores help determine the urgency of sleep studies and the type of evaluation needed. For example, patients with ESS scores ≥ 11 are more likely to have obstructive sleep apnea, while very high scores (≥ 18) may indicate narcolepsy or other hypersomnia disorders. The ESS is also used to monitor treatment effectiveness, with decreasing scores indicating successful intervention.
Public Health and Safety Applications
The ESS is used in occupational health settings to assess fitness for safety-sensitive positions, particularly in transportation and healthcare. Commercial drivers, pilots, and healthcare workers may be required to complete ESS assessments to ensure they can perform their duties safely. The scale helps identify individuals at risk for workplace accidents due to excessive sleepiness. Public health agencies use ESS data to monitor population sleep health trends and develop targeted interventions for sleep disorder prevention and management.
Personal Sleep Health Management
Individuals use the ESS for personal sleep health assessment and to track changes in their sleepiness levels over time. Regular ESS monitoring helps identify patterns that may indicate developing sleep problems or the effectiveness of lifestyle changes. Many people use the ESS as a motivator for improving sleep hygiene, seeking medical attention when needed, or evaluating the impact of sleep interventions. The scale provides a standardized way to communicate sleep concerns to healthcare providers.

Clinical Applications by ESS Score:

  • ESS 0-10: Routine health monitoring, sleep hygiene education
  • ESS 11-14: Lifestyle modification counseling, sleep study consideration
  • ESS 15-17: Comprehensive sleep evaluation, specialized testing
  • ESS 18-24: Immediate medical attention, urgent sleep disorder evaluation

Sleep Disorders Associated with High ESS Scores

  • Obstructive Sleep Apnea
  • Narcolepsy and Hypersomnia
  • Other Sleep Conditions
High ESS scores are associated with various sleep disorders and medical conditions that can significantly impact health, safety, and quality of life.
Obstructive Sleep Apnea (OSA)
Obstructive sleep apnea is the most common cause of excessive daytime sleepiness in adults. Patients with OSA typically have ESS scores of 11-17, with higher scores indicating more severe disease. OSA is characterized by repeated breathing pauses during sleep due to airway obstruction, leading to fragmented sleep and daytime sleepiness. Risk factors include obesity, large neck circumference, and anatomical airway abnormalities. Treatment with continuous positive airway pressure (CPAP) therapy typically results in significant improvement in ESS scores.
Narcolepsy and Idiopathic Hypersomnia
Narcolepsy is a neurological disorder characterized by excessive daytime sleepiness and sudden sleep attacks. Patients with narcolepsy typically have very high ESS scores (18-24) and may also experience cataplexy, sleep paralysis, and hypnagogic hallucinations. Idiopathic hypersomnia is a similar condition with excessive sleepiness but without the other symptoms of narcolepsy. Both conditions require specialized diagnostic testing and treatment with stimulant medications or other therapies.
Other Sleep Disorders and Medical Conditions
Other conditions associated with high ESS scores include restless legs syndrome, periodic limb movement disorder, circadian rhythm disorders, and insufficient sleep syndrome. Medical conditions such as depression, anxiety, chronic pain, and certain medications can also cause excessive daytime sleepiness. The ESS helps identify these conditions and guides appropriate referral for specialized evaluation and treatment.

Sleep Disorders by Typical ESS Scores:

  • Obstructive Sleep Apnea: ESS 11-17, improves with CPAP treatment
  • Narcolepsy: ESS 18-24, requires stimulant medication
  • Insufficient Sleep: ESS 11-15, improves with sleep extension
  • Restless Legs Syndrome: ESS 11-16, improves with specific medications

Limitations and Considerations of the ESS

  • Individual Variations
  • Cultural and Age Differences
  • Alternative Assessment Methods
While the ESS is a valuable screening tool, understanding its limitations is crucial for accurate interpretation and avoiding misdiagnosis.
Individual Variations and Subjective Nature
The ESS relies on self-report, which can be influenced by individual perception, memory, and willingness to report symptoms accurately. Some individuals may underreport sleepiness due to stigma or concerns about work or driving restrictions. Others may overreport symptoms to justify medical evaluation. The subjective nature of the scale means that two people with the same objective sleepiness may score differently based on their personal interpretation of the questions and their baseline sleepiness levels.
Cultural, Age, and Population Considerations
ESS interpretation may vary across different cultures, age groups, and populations. Cultural differences in sleep habits, work schedules, and attitudes toward sleepiness can affect how individuals respond to the questions. Age-related changes in sleep patterns and daytime activities may influence ESS scores in older adults. Some populations may have different baseline sleepiness levels due to lifestyle factors, making standard cutoffs less applicable. These variations require consideration when interpreting ESS scores in diverse populations.
Complementary Assessment Methods
The ESS should be used as part of a comprehensive sleep evaluation, not as a standalone diagnostic tool. Objective measures such as polysomnography, actigraphy, and the Multiple Sleep Latency Test provide complementary information about sleep quality and daytime sleepiness. Clinical history, physical examination, and other sleep questionnaires help provide context for ESS scores. The combination of subjective and objective measures provides the most accurate assessment of sleep health and guides appropriate treatment decisions.

ESS Limitations and Considerations:

  • Subjective reporting may not reflect objective sleepiness levels
  • Cultural and age differences can affect score interpretation
  • ESS should be used with other clinical and objective measures
  • Regular monitoring is needed to track changes over time