Measuring Daytime Sleepiness in Adults

Epworth Sleepiness Scale (ESS)

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Complete this and share your results with your healthcare provider.

Use the following scale to choose the most appropriate number for each situation.

It is important that you answer each item as best as you can.

Sleepiness Scale

Situation/ 

Chance of Dozing

No chance 
of dozing

Slight chance
of dozing

Moderate chance 
of dozing

High chance 
of dozing

Sitting and reading 1 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Watching TV 2 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Sitting inactive in a public place 
(e.g., a theater or a meeting)
3 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

As a passenger in a car for an hour 
without a break
4 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Lying down to rest in the afternoon while circumstances permit 5 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Sitting and talking to someone 6 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Sitting quietly after a lunch without alcohol 7 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

In a car or bus, while stopped for a few minutes in traffic 8 of 8

No chance of dozing

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

Higher scores are associated with more daytime sleepiness. You should discuss your responses and your score with your healthcare provider.

Total Score = 0

ESS © MW Johns 1990-1997. Used under License

For any information on the distribution rights for the ESS, please contact Mapi Research Trust, Lyon, France, Internet: https://eprovide.mapi-trust.org

The Epworth Sleeping Scale (ESS)

Your ESS score is:

0

An ESS score greater than 10 suggests excessive daytime sleepiness. An ESS score of 16 or higher suggests a high level of excessive daytime sleepiness. You should discuss your ESS score with your sleep specialist.

Interpreting ESS Scores

0
10
16
24
Normal levels of sleepiness
Suggests excessive daytime sleepiness (EDS)
Suggests a high level of EDS

Share these important scores with your healthcare provider

Screeners such as the ESS (above) and the Swiss Narcolepsy Scale (SNS) (below) can help screen for excessive daytime sleepiness (EDS) and narcolepsy with cataplexy (respectively), but proper diagnosis requires a complete exam from a healthcare provider, such as a sleep specialist. To help him or her make an accurate diagnosis, be open and honest about all of your symptoms and be sure to share your ESS and SNS scores.

Exploring Symptoms in Adults

Swiss Narcolepsy Scale (SNS)

The SNS assesses the frequency of 5 symptoms that can be used to screen for the presence of narcolepsy with cataplexy. Complete this and share your results with your healthcare provider.

Please choose the best answers using the scales shown for each question.

Sleepiness Scale

Interactive Scale

Never

Rarely
(Less than once a month)

Sometimes 
(1-3 times a month)

Often 
(1-2 times a week)

Almost Always

How often are you unable to fall asleep? 1 of 5

Never

Rarely (Less than once a month)

Sometimes (1-3 times a month)

Often (1-2 times a week)

Almost Always

How often do you feel bad or not well rested in the morning? 2 of 5

Never

Rarely (Less than once a month)

Sometimes (1-3 times a month)

Often (1-2 times a week)

Almost Always

Never

I would like to, but cannot

1-2 times a week

3-5 times a week

Almost daily

How often do you take a nap during the day? 3 of 5

Never

I would like to, but cannot

1-2 times a week

3-5 times a week

Almost daily

Never

Rarely
(Less than once a month)

Sometimes 
(1-3 times a month)

Often 
(1-2 times a week)

Almost Always

How often have you experienced weak knees/buckling of the knees during emotions like laughing, happiness, or anger? 4 of 5

Never

Rarely (Less than once a month)

Sometimes (1-3 times a month)

Often (1-2 times a week)

Almost Always

How often have you experienced sagging of the jaw during emotions like laughing, happiness, or anger? 5 of 5

Never

Rarely (Less than once a month)

Sometimes (1-3 times a month)

Often (1-2 times a week)

Almost Always

Negative scores are suggestive of narcolepsy with cataplexy.

Total Score = 0

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Sources: Bassetti CL. Spectrum of narcolepsy. In: Baumann CR, Bassetti CL, Scammell TE, eds. Narcolepsy: Pathophysiology, Diagnosis, and Treatment. New York, NY: Springer Science+Business Media, LLC; 2011:309-319. Sturzenegger C, Bassetti CL. The clinical spectrum of narcolepsy with cataplexy: a reappraisal. J Sleep Res. 2004;13(4):395-406. Sturzenegger C, Baumann CR, Kallweit U, Lammers GJ, Bassetti CL. Swiss Narcolepsy Scale: a valid tool for the identification of hypocretin-1 deficient patients with narcolepsy. J Sleep Res. 2014;23(suppl 1):297.

The Swiss Narcolepsy Scale

Your SNS score is:

0

An SNS calculated score that is less than 0 is suggestive of narcolepsy with cataplexy. You should discuss your SNS score with your sleep specialist.

Interpreting SNS Scores

-50
-40
-30
-20
-10
0
6
Suggests narcolepsy with cataplexy
Not suggestive of narcolepsy with cataplexy

Share these important scores with your healthcare provider

The screeners above can help screen for excessive daytime sleepiness (EDS) in narcolepsy and for narcolepsy with cataplexy, but proper diagnosis requires a complete exam from a healthcare provider. To help him or her make an accurate diagnosis, be open and honest about all of the symptoms you may be experiencing and be sure to share your scores from the screeners above.

These screening tools are not intended to make a narcolepsy diagnosis or replace complete evaluation by a sleep specialist.