Epworth Sleepiness Scale score: normal and high ranges

An Epworth Sleepiness Scale (ESS) score runs from 0 to 24 and shows how likely you are to doze off during ordinary daytime moments. Scores from 0 to 10 are in the normal range, 11 to 15 means you’re sleepier than most people, and 16 or more means you’re very sleepy by day. A score of 11 or more is worth mentioning to a doctor, because sleepiness like this often has a cause that can be found and helped. The score shows how sleepy you are, not why.

What does the Epworth Sleepiness Scale measure?

The Epworth Sleepiness Scale measures daytime sleepiness: how easily you fall asleep when you aren’t trying to. It was developed by Australian doctor Murray Johns at Epworth Hospital in Melbourne and published in 1991 in the journal Sleep. Doctors and sleep clinics all over the world use it as a first measure when someone says they’re sleepy during the day.

Its strength is that it doesn’t ask “how sleepy do you feel?”, which people answer in very different ways. It asks how likely you would be to actually doze off in eight specific, everyday situations. That makes the answers easier to compare from one person to the next, and from one month to the next for the same person.

The daytime sleepiness test on Sprout uses the Epworth Sleepiness Scale and takes about two minutes. Taking the test is free; results need Sprout Plus (7 days free).

What are the eight Epworth situations?

The eight Epworth situations ask about dozing while reading, watching television, sitting in public, travelling, resting, talking, sitting after lunch and waiting in traffic. For each one, you say how likely you’d be to doze off, thinking about your usual life lately:

1. Sitting and reading
2. Watching television
3. Sitting still in a public place, like a theatre or a meeting
4. Being a passenger in a car for an hour without a break
5. Lying down to rest in the afternoon when you get the chance
6. Sitting and talking to someone
7. Sitting quietly after a lunch without alcohol
8. In a car, while stopped for a few minutes in traffic

Each answer scores from 0 to 3:

• Would never doze: 0
• Slight chance of dozing: 1
• Some chance of dozing: 2
• High chance of dozing: 3

Add the eight together for a total from 0 to 24. If you haven’t done one of these things recently, you imagine how it would affect you rather than skipping it. The mix is deliberate. Almost anyone might drift off lying down in the afternoon, so a 2 there means little on its own. Dozing while talking to someone, or while stopped in traffic, is much less common, and a score there says more.

What is a normal Epworth Sleepiness Scale score?

A normal Epworth score is 10 or below. Most people without a sleep problem fall somewhere in that range, and many get a little drowsy in quiet moments, after lunch or on a long car journey, without anything being wrong.

The third column uses the wording the scale’s author gives for each range. The important line is between 10 and 11: from 11, sleepiness is more than ordinary drowsiness and is usually described as excessive.

What does each Epworth range mean in everyday life?

The Epworth ranges describe how readily you doze during the day. The lower ranges cover ordinary drowsiness; the higher ones suggest sleepiness that needs attention.

0 to 5: not sleepy by day

You rarely nod off, even in quiet, restful moments. If you do feel tired, it’s more likely the ordinary kind of tiredness than a struggle to stay awake. That’s useful to know if you feel exhausted, because it suggests looking beyond sleepiness: at how restful your nights are, at stress or at mood.

6 to 10: a little sleepy

You sometimes get drowsy in quiet moments, as lots of people do. If you’d like to feel more alert, a regular sleep routine and enough time in bed can make a difference. A score near 10 that has crept up from a lower one is worth watching.

11 to 12: sleepier than most

You’re a bit more likely to nod off during the day than most people. This can happen when you don’t get enough sleep, or when your sleep isn’t as restful as it could be. It’s worth mentioning to your doctor, especially if it’s been going on for a while.

13 to 15: quite sleepy

You’re quite likely to nod off during everyday activities. That can make days feel like hard work and affect your concentration, mood and safety. Sleepiness like this often has a cause that can be found and helped, so get it checked, and avoid driving when you feel drowsy.

16 to 24: very sleepy

You’re very likely to fall asleep during ordinary daytime activities. That’s a lot to cope with, and it can put you at risk, especially on the road or at work. Try to see a doctor soon, as there’s often a clear reason for this much sleepiness that can be treated. Until then, please don’t drive when you feel drowsy.

Is a high Epworth score something to worry about?

A high Epworth score is a reason to discuss daytime sleepiness with a doctor. It gives that conversation a measurable starting point, but it doesn’t say what’s causing the sleepiness.

The most everyday explanation is simply not enough sleep: late nights, early starts, a new baby or a long commute add up. Shift work, broken nights, some medicines and alcohol can all add to it too. Sometimes the cause is something happening during sleep that you aren’t aware of, which is why a doctor is the right person to look into a high score. Doctors use the Epworth when they consider sleep conditions such as sleep apnoea or narcolepsy, but a high score on its own doesn’t mean you have either. It means it’s worth finding out.

Before an appointment, a few notes help more than the number alone:

• Your usual hours. When you go to bed, when you get up, and roughly how long you sleep on workdays and days off.
• What others have noticed. If a partner or family member has heard loud snoring, gasping or pauses in your breathing at night, say so.
• When the sleepiness started. After an illness, a new medicine, a change of job, or gradually over years.
• Any near misses. Nodding off while driving, even for a moment, is important to mention.

A doctor will usually want to rule out medical causes first and may refer you to a sleep clinic if needed. Many causes of daytime sleepiness respond well to treatment, and people are often surprised how different days feel once it’s sorted.

Can you be exhausted and still score low on the Epworth?

Yes. The Epworth measures sleepiness, the tendency to fall asleep, rather than exhaustion alone. Many people are worn out, heavy and drained during the day but can’t nap even when they try. That’s fatigue, and it scores low on the Epworth.

A low score with a lot of tiredness points somewhere other than daytime sleepiness. It often fits insomnia, where people feel tired but wired, lie awake at night and can’t doze off by day either. The ISI score ranges cover that pattern. It can also fit low mood, long-running stress or burnout, or a physical cause. The post on tiredness that won’t lift sorts through those options, and the early burnout signs are worth a look if work has been draining you for months.

What can affect your Epworth answers?

Confusing tiredness with dozing, getting used to sleepiness or answering for an unusual week can affect your Epworth score. The questions rely on your estimate of how likely you are to fall asleep in each situation.

• Reading “tired” as “dozing”. The questions ask about actually nodding off. Feeling bored or heavy-eyed in a meeting without falling asleep isn’t the same.
• Getting used to it. People who have been sleepy for years sometimes stop noticing how often they doze. Asking someone you live with can help.
• A recent unusual week. A run of late nights, jet lag or a new baby raises the score for a while. Answer for your usual life lately, not just the last day or two.
• Avoiding situations. If you’ve stopped reading or driving because you drop off, imagine how they would go rather than answering 0.
• Caffeine. Lots of coffee can hide sleepiness, so your score may be lower than how sleepy you’d be without it.

How does the Epworth fit with other sleep checks?

The Epworth looks only at the day. It doesn’t ask about your nights at all, so it pairs well with a questionnaire that does.

The Pittsburgh Sleep Quality Index looks at the whole past month of nights, in seven parts, from how long it takes you to fall asleep to how often you wake. If your Epworth score is high and you don’t know why, it can show which part of your nights is struggling; the seven PSQI components show what it measures. The Insomnia Severity Index focuses on lying awake and how much that bothers you.

None of these is a diagnosis. Together they give a doctor a much fuller picture than “I’m tired all the time”.

What should you do after a high Epworth score?

If you scored 11 or more, the most useful next step is to book a conversation with a doctor and bring your score. In the meantime:

• Don’t drive when drowsy. If you feel sleepy at the wheel, stop somewhere safe. This matters most at 13 and above.
• Give yourself enough time in bed. For a week or two, protect a full night and see whether the sleepiness eases. If it does, short sleep was likely a large part of it.
• Keep a steady wake-up time. A regular rhythm helps your body know when to be alert.
• Notice alcohol and late caffeine. Both can make sleep lighter, which can leave you sleepier the next day.
• Keep naps short and early. If you take them at all, keep them from eating into the night.

If you scored 10 or below but still feel worn out, take that seriously too. A normal Epworth score says you rarely doze off without meaning to. It doesn’t measure feeling drained, low or worn out.

How often should you retake the Epworth?

About once a month is a good rhythm. That’s often enough to notice a change without reacting to one unusually tired week.

It’s especially useful after a change: more time in bed, a new routine, or a treatment a doctor has suggested. A score that falls from 14 to 8 tells you, and your doctor, that the change is working. A score that stays high despite more sleep is a sign to go back and look further.

To get your own number, or check how it has moved since last time, take the two-minute Epworth check.