The Epworth Sleepiness Scale (ESS) is a validated 8-item self-report of average daytime sleepiness. For each situation, rate how likely you would be to doze off or fall asleep—not just feel tired—in recent times, even if you have not done some of these things lately. Pick the answer that best fits.
- 0 — Would never doze
- 1 — Slight chance of dozing
- 2 — Moderate chance of dozing
- 3 — High chance of dozing
Score interpretation (total 0–24):
- 0–10: Normal daytime sleepiness
- 11–14: Mild excessive daytime sleepiness
- 15–17: Moderate excessive daytime sleepiness
- 18–24: Severe excessive daytime sleepiness
The conventional threshold is ESS ≥11 = excessive daytime sleepiness.
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When to Use
Appropriate population
- CKD/ESRD patients — sleep disturbance and OSA are common; daytime sleepiness may signal under-dialysis, uremia, anemia, or untreated sleep apnea
- Pre-transplant and CKD workup where sleep quality and OSA risk affect outcomes
- Any patient reporting daytime sleepiness, fatigue, snoring, or witnessed apneas
- Monitoring response to CPAP or other sleep-disorder treatment over time
Pearls & Pitfalls
Key pearls
- The ESS is a subjective measure of average daytime sleepiness — it is not diagnostic. A normal ESS does not exclude OSA
- It complements the PSQI (overall sleep quality) and STOP-BANG (OSA risk) — use them together for a fuller picture
- A high ESS (≥11) warrants evaluation for obstructive sleep apnea or another sleep disorder, including polysomnography where indicated
- In CKD and dialysis patients, daytime sleepiness has many overlapping causes (uremia, anemia, OSA, restless legs, sedating medications, depression) — interpret in context
- Track the score over time: a falling ESS after CPAP or dialysis-prescription change suggests treatment benefit
Why Use It
Excessive daytime sleepiness is common yet under-recognized in CKD and dialysis populations, where sleep disturbance and obstructive sleep apnea frequently coexist. A simple, validated score quantifies how sleepy a patient really is, flags those who need formal sleep evaluation, and gives an objective way to follow the response to treatment.
Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in each situation below, in contrast to just feeling tired? The total score and category update automatically.
Rate each situation (0 = never doze … 3 = high chance)
⚕ The Epworth Sleepiness Scale is a subjective screening tool, not a diagnostic test. A normal score does not exclude obstructive sleep apnea. For educational reference only. Reference: Johns MW, Sleep 1991.
Next Steps
- Score ≥11: Excessive daytime sleepiness — evaluate for OSA or another sleep disorder; combine with STOP-BANG and consider polysomnography or home sleep apnea testing
- Score 0–10: Normal range, but a normal ESS does not exclude OSA; pursue testing if snoring, witnessed apneas, or strong clinical suspicion persist
- CKD / dialysis context: Review for contributing factors (under-dialysis, anemia, restless legs, sedating drugs, depression) alongside sleep-disorder workup
- On treatment: Re-administer the ESS to track response to CPAP or other interventions
Evidence & References
References
- Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540–545.
- Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376–381.
- Kapur VK, et al. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea. J Clin Sleep Med. 2017;13(3):479–504.
