Epworth Sleepiness Scale

Rate how likely you are to doze off or fall asleep in the following situations. Insert a 1 in the appropriate response column. 

Sitting, inactive, in a public place (e.g., in a movie theater or a meeting) 

Lying down to rest in the afternoon (when circumstances permit) 

Sitting quietly after lunch (without alcohol) 

Raw score Multiply the raw score by Column totals Overall total (sum of column total) 

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EDS, of any cause, is common. The exact prevalence is difficult to determine, since sleepiness is not an all-or-none phenomenon, but it can be estimated. Using a subjective scale, the Epworth Sleepiness Scale (ESS), about 26% of normal subjects score >10 and about 2.5% score >15 (1). Using an objective method, the MSLT, about 32% of subjects score in the severely sleepy range (2). In addi-... 

Figure 2 The Epworth Sleepiness Scale. Each question is answered with a number from 0 (not at all likely to fall asleep) to 3 (very likely to fall asleep). This yields a total of 0 (minimum) to 24 (maximum), and scores above 10 are thought to warrant investigation.

Johns MW. A new method of measuring sleepiness the Epworth Sleepiness Scale. Sleep 1991 14 540-545. 

Hardinge FM, Pitson DJ, Stradling JR. Use of Epworth Sleepiness Scale to demonstrate response to treatment with nasal continuous airway pressure in patients with obstructive sleep apnoea. RespirMed 1995 89 617-620. 

Johns MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep 1994 17 703-710. 

Benbadis SR, Mascha E, Perry MC, Wolgamuth BR, Smolley LA, Dinner DS.. Association between Epworth Sleepiness Scale and MSLT in a clinical population. Ann Intern Med 1999 130 289-292. 

Chervin R, Aldrich MS, Pickett R, Guilleminault C. Comparison of the results of Epworth Sleepiness Scale and multiple sleep latency test. J Psychosom Res 1997 42 145-155. 

Smolley LA, Ivey C, Farkas M, Faucette E, Murphy S. Epworth Sleepiness Scale is useful for monitoring daytime sleepiness. Sleep Res 1993 22 389. 

Sander AM, Mohan KK, Axelrod BN, Nahhas A, Kapen S. The Epworth Sleepiness Scale an unworthy adversary to clinical interview. Sleep Res 1996 25 355... 

Sangal RB, Mitler MM, Sangal JM. Subjective sleepiness ratings (Epworth Sleepiness Scale) do not reflect the same parameter of sleepiness as objective sleepiness (maintenance of wakefulness test) in patients with narcolepsy. Clin Neurophysiol 1999 110 2131-2135. 

Perhaps the most common type of verbal report used in sleep deprivation studies is a measure of subjective sleepiness. Subjective sleepiness is generally assessed by self-report scales (see also Chap. 1), such as the Stanford Sleepiness Scale (19), the Epworth Sleepiness Scale (20), visual analog scales (21), and the vigor and fatigue subscales on the Profile of Mood States (POMS Educational and Industrial Testing Service, San Diego, CA). These measures have been used in studies on the effects of sleep deprivation (22-25), shift work (26-28), and sleep disorders (29,30). 

Johnson S. How sleepy are practicing physicians A field trial of the Epworth Sleepiness Scale. Sleep Res 1997 26 671. 

One could reasonably believe that complaining of chronic daytime somnolence is a major risk for traffic accidents. Surprisingly, studies on patients suffering from chronic daytime somnolence (9,10) failed to find a link between the risk of traffic accidents and sleepiness measured on a behavioral scale (i.e., Epworth Sleepiness Scale). This could be explained by the fact that subjective questionnaires do not correlate with objective measures of daytime vigilance (11). Another possible explanation could be that sleepiness is dangerous only when perceived during at risk activities. 

Subjective (e.g., Epworth Sleepiness Scale) and objective [e.g., Multiple Sleep Latency Test (MSLT)] daytime somnolence quantification does not seem to provide valuable information on patients risks. This could be explained by the fact that sleep-related accidents occur at certain times when behavioral and chronobiological factors play an important role. Medical and legal issues could nevertheless require an objective test, such as the Maintenance of Wakefulness Test (MWT), to confirm that treated apneic patients present a normal level of vigilance. 

Chervin RD, Aldrich MS. The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea. Neurology 1999 52 125-131. 

Daytime vigilance has been assessed in 14 newly diagnosed never medicated adults with focal epilepsy at baseline and 2 months after slow titration of topiramate to 200 mg/day (653). Multiple Sleep Latency Test (MSLT), visual simple and choice reaction time (VRT), and selfrating with the Epworth Sleepiness Scale were used for quantification of sleepiness, and compared with 14 healthy volunteers. At baseline MSLT scores were comparable. Two months after topiramate monotherapy, MSLT, VRT, and self-rating did not change significantly. 

Check and review your shift-work arrangements regularly. Includes suggested performance measures such as the HSE Fatigue and Risk Index Tool and Epworth sleepiness scale. 

Johns, M.W. (1991). A new method for measuring daytime sleepiness the Epworth sleepiness scale. Sleep, 14(6), 540-545. 

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