The Epworth Sleepiness Scale: How To Use It To Get a Good Night’s Sleep

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How often do you feel sleepy during the day? Have you ever fallen asleep at work or had trouble staying awake while driving, even after a good night’s rest? If so, you’re not alone. Sleep disorders, or conditions that affect sleeping patterns, affect an estimated 50 to 70 million Americans.Sleep disorders come in many forms, with many leading to excessive sleepiness throughout the day. The Epworth Sleepiness Scale is a self-assessment tool that evaluates your level of daytime sleepiness. The results can help determine whether you have a sleep disorder. Read on to learn more about the Epworth Sleepiness Scale, how it works, and where you can get a copy online. 

What Is the Epworth Sleepiness Scale?

The Epworth Sleepiness Scale was developed in 1990 and is now the gold standard used worldwide to help identify sleep problems in adults. 

There are eight questions on the Epworth Daytime Sleepiness Scale, which asks you to rate your likelihood of falling asleep or dozing off during different activities. Most adults regularly encounter these scenarios requiring different levels of attention or engagement. You’re asked to consider your typical behavior or how you might behave if faced with these situations and then rate each question on a four-point scale.

The self-administered questionnaire is designed for adults to assess their sleepiness level during the day. There is a questionnaire modified for the activities of children and adolescents called the ESS-CHAD.

How Is the Epworth Sleepiness Scale Used To Diagnose Sleep Disorders?

An Epworth Daytime Sleepiness Scale score alone cannot diagnose a sleep disorder. However, it can help you measure your level of daytime sleepiness and determine whether it is normal or excessive. Talking to your doctor about your results can help you determine how to treat sleep deprivation.

When taking the Epworth Sleepiness Scale, you will be asked to rate your level of sleepiness in different scenarios between zero to three. The number zero indicates that you would never fall asleep in such a situation, while the number three means that you would be very likely to doze off. Scores for each question are totaled to determine your final score, ranging between zero and 24. The score total determines whether your daytime sleepiness is normal or excessive.

The official Epworth Sleepiness Scale website lists the score ranges as follows:

  • 0-5 — Lower Normal Daytime Sleepiness
  • 6-10 — Higher Normal Daytime Sleepiness
  • 11-12 — Mild Excessive Daytime Sleepiness
  • 13-15 — Moderate Excessive Daytime Sleepiness
  • 16-24 — Severe Excessive Daytime Sleepiness

Scores between zero and ten are considered normal, while scores between 11 and 24 reflect increased sleepiness. Scores above 11 indicate excessive sleepiness during the day, which you should discuss with your doctor to determine whether there is an underlying cause of your daytime sleepiness.

Your sleep score, along with a physical examination and your medical history, can help your doctor understand the nature of your sleep problem. A sleep specialist may diagnose a sleep disorder or recommend how to treat sleep deprivation due to excessive sleepiness during the daytime.

What Is Excessive Daytime Sleepiness?

Excessive daytime sleepiness is a common problem that can cause challenges in getting through your day-to-day routine. 1 in 5 American adults reports feeling extremely sleepy during the day. It’s one of the top reasons for people to visit sleep clinics. 

The International Classification of Sleep Disorders (ICSD) defines excessive daytime sleepiness as persistent daytime sleepiness, often accompanied by unintentional dozing, for at least three months. Excessive sleepiness is usually caused by sleep disorders but can also result from certain medications, medical conditions, or lifestyle choices.

When untreated, extreme sleepiness can have serious consequences, including job and road accidents. Approximately 71,000 injuries and more than 6,400 deaths occur yearly from drowsy driving. In addition, workers who are overly sleepy during the day are 2.5 times more likely to have work-related accidents.

Chronic sleep deprivation is also associated with other health conditions. These include heart conditions, strokes, high blood pressure, diabetes, depression, and delayed growth in children. Seniors are particularly at risk, as sleep deprivation can lead to falls and increase the risk of cognitive decline and memory loss.

What Are Some of the Most Common Causes of Excessive Daytime Sleepiness?

There are over 80 distinct sleep disorders, many of which cause excessive daytime sleepiness. Some of the most common sleep disorders include:

  • Sleep apnea interrupts breathing during sleep, which results in frequent wakings. Common symptoms include heavy snoring, waking up breathless, and morning headaches.
  • Restless legs syndrome is characterized by an uncontrollable desire to move one’s legs while falling asleep or sitting still, sometimes accompanied by tingling or other sensations.
  • Insomnia is a problem with falling and staying asleep.
  • Narcolepsy is a disorder that causes people to lose consciousness suddenly and uncontrollably during the day.

Many other factors can also contribute to excessive daytime sleepiness. Whether prescribed or over-the-counter, many medications can cause daytime drowsiness. Examples of medications that can produce sleepiness include stronger pain medications such as opioids, muscle relaxants, seizure medications, and antihistamines such as Benadryl. A detailed review of your medication list with your doctor can sometimes help pinpoint medications that could be stopped, reduced, or changed to improve wakefulness throughout the day. 

Sleepiness may also be caused by medical conditions and mental health issues, such as anemia and depression. Lifestyle factors such as shift work, alcohol consumption, and caffeine intake can also disturb sleep. While a glass of whiskey may help you feel sleepier at night, alcohol actually results in worse sleep quality and causes you to have a less restful sleep. It is best to avoid the extra cup of coffee or glass of wine at night to ensure that you achieve the best sleep quality.

Where Can You Get a Copy of the Epworth Sleepiness Scale Questionnaire?

The Epworth Sleepiness Scale is the only validated questionnaire for evaluating excessive daytime sleepiness. The Epworth Sleepiness Scale is widely available online in printable and digital versions, and both formats are considered credible.

Harvard University’s website offers a free online Epworth Sleepiness Scale questionnaire. You can also download the Narcolepsy Screening App to take the test on an Apple or Android smartphone. If you prefer a paper form, print the free Epworth Sleepiness Scale PDF from the Centers for Disease Control and Prevention (CDC) for your doctor to review. 

Doctors or sleep specialists can also administer the Epworth Sleepiness test in the office.

The Next Steps to Better Sleep

If you think you might be experiencing excessive daytime sleepiness, complete the Epworth Sleepiness Scale questionnaire and discuss your results with your doctor. Your Epworth sleepiness score and other symptoms and tests can be a great starting point for you and your doctor to discover the cause of your sleepiness. The correct diagnosis and treatment can help you get some rest and return to enjoying life to its fullest.