The Epworth Sleepiness Scale (ESS)
By: Carole Smyth MSN, APRN, BC, ANP/GNP, Montefiore Medical Center
WHY: A good sleep at night promotes health. Daytime sleepiness can be an antecedent to falls, vehicular accidents, household fires, decreased quality of life, and decreased functional recovery in older adults. Sleepiness during the day may also signal uncontrolled hypertension and diabetes (Cuellar & Ratcliffe, 2008; Goldstein, Ancoli-Israel, Shapiro, 2004), unrecognized depression (Magliore, et al, 2012) and/or sleep disordered breathing (Khan, 2013). Assessment of daytime sleepiness enables the nurse to intervene by conducting further nursing assessments, educating and implementing interventions with the client and/or caregiver, or by referring the client for further assessment.
BEST TOOL: The Epworth Sleepiness Scale (ESS) is an effective instrument used to measure average daytime sleepiness. The ESS differentiates between average sleepiness and excessive daytime sleepiness that requires intervention. The client self-rates on a four point Likert scale how likely it is that he/she would doze in eight different situations. Scoring of the answers is 0-3, with 0 being “would never doze” and 3 being “high chance of dozing.” Scoring of the ESS was modified in 1997 to reflect greater accuracy; scores above 10 indicate excessive daytime sleepiness (Johns, 1997).
TARGET POPULATION: The ESS may be used for both initial assessment and ongoing comparative measurements with older adults across the health care continuum. The ESS is not an appropriate tool for measuring changes in sleep over a period of hours.
VALIDITY AND RELIABILITY: There is a high level of internal consistency between the eight items in the ESS as measured by Cronbach’s alpha, ranging from 0.73 to 0.90. Numerous studies using the ESS have supported high validity and reliability. Cross-cultural use of the ESS has required adaptations in items 3 and 8 due to concerns that respondents do not drive or use a car, but have maintained the high level of internal consistency (Bajpai et al., 2016; Zhang et al., 2011)
STRENGTHS AND LIMITATIONS: The ESS is a subjective measure of daytime sleepiness. Self reporting by clients though empowering, may be limited by perception and may reflect inaccurate information if the client has difficulty understanding what is written, or cannot see or physically write out responses. The ESS has been translated into Spanish, Portuguese, Italian, German, Swedish, Finnish, Greek, French, Mandarin, Japanese, Hindu, Thai, Amharic, and Turkish. Baldwin emphasized differences in translation between Mexican-Americans and other Spanish speaking populations. Pictorial and written versions of the ESS for online distribution has been created in English and maintained reliability and validity (Boyes, et al, 2017; Drakatos, et al. 2015). The tool has not been validated for phone interviews.
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Best practice information on care of older adults: https://consultgeri.org.
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