Up to a fourth of the people in the United States experience excessive daytime sleepiness. Excessive daytime sleepiness is the sensation of feeling incredibly tired, as if you can't keep your eyes open. It is a symptom that can impact a person's daily life by impairing concentration, reducing their ability to perform well at work in school, and increasing the risk of accidents.

One way to determine if you have excessive daytime sleepiness is by using the Epworth Sleepiness Scale. The ESS is a tool that can help doctors determine if you have drowsiness that is of concern or is just a manifestation of poor sleep habits at night. This simple questionnaire is used to determine how a person's sleepiness affects their everyday life.

For people who are concerned about their ability to stay alert during the day, using the ESS, knowing how it works, and knowing what the results mean can help you learn more about your own health. It can also help you engage with conversations with your physician about what your symptoms mean and what to do next period continue reading to learn more about the ESS and how to use it in your journey towards getting a good night's sleep.

The Epworth Sleepiness Scale, or ESS, is a short questionnaire designed to assess daytime sleepiness. This is a basic test that includes a self-assessment on how likely a person is to fall asleep in eight different situations. Physicians and sleep experts may use this data to help them identify if one of their patients is struggling with excessive daytime sleepiness. Answering questions on this questionnaire only takes a few minutes, and can be done on paper or electronically. The settings of where this questionnaire can take place include the home, clinic, hospital, school, job, anywhere where one can take a questionnaire.

What is excessive daytime sleepiness?

Excessive daytime sleepiness (EDS) is a disruption of daily life due to drowsiness that can arise when someone needs to be awake or alert. This could include working, driving, any activity that involves needing one's full attention. EDS can interfere with many aspects of one's life, and increase the risk of serious accidents happening, especially when one is operating heavy machinery or driving a car.

Excessive daytime sleepiness is not a sleeping disorder, but rather a symptom or manifestation of an underlying sleeping disorder. Causes of excessive daytime sleepiness can include sleeping disorders including obstructive sleep apnea, narcolepsy, restless leg syndrome, etc. There are also other conditions that can affect physical and mental health, including insomnia, depression, anxiety, that can also cause excessive daytime sleepiness. The causes of excessive daytime sleepiness are so wide ranged, that is important to figure out exactly if someone is experiencing excessive daytime sleepiness, and then whittling down why.

How the ESS identifies excessive sleepiness

The ESS applies a standardized method to measure a person's evaluation of their own daytime drowsiness. These questions are designed to figure out if a person is more likely to doze off in a situation or not. These situations are normally typical daytime activities, and can identify if a person struggles to stay alert in those situations.

Doctors can use the results of the ESS to detect excessive daytime sleepiness. They can also use the scale to assess the severity and the impact on daily life. Once they establish a baseline, they can continue using the ESS to determine how much someone changes over time. This becomes especially important when they begin to treat a sleeping disorder and want to see if there is improvement. The reason the ESS is important for doctors is because symptoms can be very subjective. This can make it increasingly difficult for physicians to identify symptoms that are common to specific sleeping disorders. This standardized form allows doctors one way to describe a variety of symptoms and determine the extent of one's excessive daytime sleepiness.

The shortcoming of ESS is that it cannot diagnose excessive daytime sleepiness alone, or any sleeping disorder. The ESS is simply a screening tool that identifies if excessive daytime sleepiness is something that someone is experiencing. If someone tests positive, then that triggers additional tests needed for an official diagnosis.

Who benefits from the ESS?

The ESS can be helpful for people who experience difficulty staying awake and alert during the daytime. It generates a score that can measure daytime sleepiness, and the results can help physicians determine the severity and presence of excessive daytime sleepiness in their patients. As part of the initial workup of excessive daytime sleepiness, the ESS provides a quick and efficient measurement to determine what the next steps need to be in the workup of excessive daytime sleepiness. Most of the questions focus on ones ability to fall asleep during specific activities, however the ESS may help distinguish between actual excessive daytime sleepiness and just general fatigue.

ESS may also benefit those who have been diagnosed with excessive daytime sleepiness because the test can be taken at multiple time points to monitor progress or track symptoms.

How does the ESS work?

The ESS works by asking a person to rate on a scale of zero to three how likely they are to fall asleep in various situations. A rating of 0 means that they will never fall asleep while a rating of three means that they have a high likelihood of going to sleep in those situations. The situations Include:

• Reading while sitting down
• Watching television
• Sitting in actively in a public setting
• Riding passenger for one consecutive hour in a car
• Lying down to rest in the afternoon
• Sitting and talking with a different person
• Sitting quietly after lunch without having consumed alcohol
• Sitting in the driver's seat of a car while sitting at a stop or for a few minutes in traffic

The questionnaire can be offered as a one page form that is filled out in a doctor's office. The test can also be sent electronically through a secure patient portal. The doctor may also read the questions out loud and provide a score on the spot if that is something that your physician office offers. Once a rating has been provided for each of the situations, the overall score can be summed up to see where it falls on the scale.

How the ESS score is calculated

Calculating the ESS score is very straightforward. For each of the eight questions, there is a score of zero to three. This means that the total score can be anywhere from zero to 24. Those who score zero to 10 reflect normal levels of daytime sleepiness. Those who score over 10 are considered to reflect excessive daytime sleepiness.

It's important to note that the ESS score alone is not definitive for determining if someone has excessive daytime sleepiness. Their score may vary if taken at different times, and in-depth studies on this scale are limited. Therefore, the scores must be considered along with someone's medical history, physical exam, other symptoms, and if necessary additional testing like a sleep study.

Can the upward sleepiness scale be used for children and adults?

The ESS was developed for adults, however, a version of the test for adolescents and children has been designed. The modified test, which is known as the Epworth Sleepiness Scale for Children and Adolescents follows the same structure as the test for adults but has a few changes in the questions and how they are presented. When the ESS-CHAD is used in children under 10, assistance from an adult is necessary. The test is just one test, and is available to help diagnose sleeping disorders that may be present in children.

If you are concerned that you may be struggling with sleep, or excessive daytime sleepiness, and think that you would benefit from taking the F word sleepiness scale, then please click the orange button below to take a free online sleep test and get in contact with one of our sleep health professionals.

https://www.sleepfoundation.org/sleep-studies/epworth-sleepiness-scale