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Daytime Sleepiness Scale: Your 0 to 24 Score and Sleep Apnea Signals

An eight-situation daytime sleepiness scale scored 0 to 24, asking what actually happened over the past two weeks, plus four questions about snoring and breathing in sleep. You get a sleepiness band, a separate count of sleep apnea signals, and a clear account of when the combination is the standard trigger for a sleep study.

  • Screener
  • About 4 min
  • Original items, modeled on the Epworth Sleepiness Scale structure
  • Runs in your browser, nothing is sent
  • Medical review: Medical review pending
Start the test

Three things this scale separates

Daytime sleepiness, the tendency to actually fall asleep when you do not mean to, is different from tiredness and different from poor sleep at night. Scoring it on its own, and counting the breathing signals separately, keeps the two questions that matter apart: how sleepy are you, and is there a reason to look for sleep apnea.

  1. 8

    Daytime sleepiness score

    Eight concrete situations from the past two weeks, each asking how often you actually fell asleep or had to fight to stay awake, scored 0 to 3 for a total of 0 to 24. The situations and the response labels are our own, and the eight-item, 0 to 24 shape is the one clinical sleepiness questionnaires use.

  2. 4

    Sleep apnea signals

    Four yes or no questions about loud snoring, breathing pauses or gasping, morning dry mouth or headache, and waking unrefreshed. Counted separately as context, never added to the sleepiness score, because they point to a cause rather than measuring sleepiness itself.

  3. 1

    The drowsy-driving floor

    One item asks about fighting sleep at the wheel. If it happened three or more times in two weeks, the result is raised to at least the notable band whatever the total, because drowsy driving is the situation where sleepiness causes harm fastest.

How this compares with a typical online quiz

FeatureTypical free quizRegenerated.com
Items modeled on a published scaleOften a copy of the licensed scaleYes, original situations in our own wording, with the model named once and cited
Asks what happened, not what might happenHypothetical chance of dozingActual episodes over the past two weeks
Sleep apnea signals counted separatelyRarelyYes, four signals and the referral trigger explained
Drowsy driving raises the resultNoYes, a floor on the driving item
Says what a sleep study is and who orders itNoYes, home sleep apnea test versus in-lab polysomnography
Answers sent to a serverOftenNever; scored in your browser, counts-only events

How this scale is scored, and how it relates to the questionnaire a clinic uses

Each of the eight situations is scored 0 (not once), 1 (once or twice), 2 (three to five times) or 3 (six times or more) over the past two weeks, for a total of 0 to 24. The bands are educational: 0 to 5 low, 6 to 10 mild, 11 to 15 notable and 16 to 24 high. They sit near the cut-offs published for the licensed sleepiness questionnaire this page is modeled on, where 0 to 10 is treated as the normal range and 11 to 24 as excessive daytime sleepiness, so that a reader who has seen a clinic score knows roughly where this result would fall. Those cut-offs were validated on that questionnaire's own items, not on the items here, and a score on this page is not a score on it.

The questionnaire this page is modeled on was published by Murray Johns in 1991, is licensed through Mapi Research Trust, and asks how likely you would be to doze in eight situations it lists. The items on this page are deliberately written in a different register: they name their own situations and ask how often you actually fell asleep or had to fight sleep in a fixed two-week window. That makes the score a record of what happened rather than a rating of likelihood, which is easier to answer honestly and easier to compare over time, at the cost of not being the validated instrument. A sleep clinic will ask you to complete its own questionnaire when you are referred; bring this result and a two-week sleep diary with you.

When sleepiness points to sleep apnea: the referral trigger

The pattern sleep clinics look for is daytime sleepiness together with loud snoring, witnessed pauses in breathing, or waking choking or gasping. The American Academy of Sleep Medicine's 2017 diagnostic guideline treats that combination as a reason to test, and it is why the four signals on this page are counted next to the sleepiness score. A sleepiness result in the notable or high band with one or more signals is the standard trigger for asking a clinician about a sleep study. High blood pressure that is hard to control, type 2 diabetes, a larger neck, and being male or past fifty each raise the likelihood further.

The test itself is either a home sleep apnea test, a small device worn for one or two nights that records breathing, oxygen and effort, or an overnight polysomnography in a sleep laboratory, which also records brain activity and is used when other sleep disorders are possible or a home test is inconclusive. The guideline says questionnaires alone, including this one, must not be used to diagnose sleep apnea or to rule it out, and the US Preventive Services Task Force found in 2022 that there is not enough evidence to screen adults who have no symptoms. Sleepiness with snoring is a symptom; that is the point at which testing is justified.

Sleepiness is not the same as fatigue

Sleepiness is the pressure to fall asleep: eyes closing, nodding, losing minutes. Fatigue is a lack of energy or the sense that effort costs more than it should, and a fatigued person often cannot nap even when they try. The distinction matters because the causes differ. Sleepiness usually comes from too little sleep, broken sleep as in sleep apnea or restless legs, a sedating medicine, or less often a disorder of sleep regulation such as narcolepsy. Fatigue without sleepiness points more often toward anemia, thyroid disease, depression, a long infection, or a chronic fatigue pattern.

A low score on this page with heavy fatigue is a real finding, not a reassurance: it suggests looking outside sleep for the cause. A high score with very few hours in bed suggests the plainest explanation first, insufficient sleep, which a two-week sleep diary will show before any test is needed. A high score with seven or more hours in bed and any of the breathing signals is the pattern that most deserves a sleep study.

Methodology and sources

This is our own daytime sleepiness screener. Eight situations we chose ourselves are each scored 0 to 3 and summed to a total of 0 to 24, and each one asks how many times the reader actually fell asleep or had to fight to stay awake during the past two weeks. The construct it measures, unintended daytime sleep, was defined for clinical use by Murray Johns in 1991 in the instrument cited below, a copyrighted questionnaire licensed through Mapi Research Trust that instead asks for the chance of dozing in eight situations of its own. We did not take its situations, its response labels, its time window or its scoring, so its published reliability and validity data do not transfer here, and a score from this page is a research-informed screening result rather than a validated score. Part 2 asks about the clinical features of obstructive sleep apnea named in the American Academy of Sleep Medicine's guidelines, in our own wording and order, and is reported as a count rather than a risk score.

The four bands are ours and are educational: 0 to 5, 6 to 10, 11 to 15 and 16 to 24. They sit near the thresholds used clinically, where 0 to 10 out of 24 is read as a normal range, 11 and above as excessive daytime sleepiness and 16 and above as severe, so that a reader who already has a clinic score can place this one. Those thresholds were established on another instrument's items and in clinic populations, not on these items, so a result here should be read as a band rather than a point. The drowsy-driving floor is an editorial choice, not a published rule: fighting sleep at the wheel three or more times in two weeks is treated as enough on its own to deserve the notable band and a clinician's attention.

No questionnaire can distinguish sleep apnea from insufficient sleep, a sedating medicine, narcolepsy, depression or thyroid disease, all of which can produce the same sleepiness. A clinician makes that distinction with a sleep history, a review of medicines, an examination and, where the pattern fits, a home sleep apnea test or in-laboratory polysomnography. The American Academy of Sleep Medicine guideline is explicit that questionnaires, including this one, are not a substitute for that testing in either direction.

Medical review: Medical review pending. Last updated .

References

  1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545. doi:10.1093/sleep/14.6.540
  2. Kapur VK, Auckley DH, Chowdhuri S, et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(3):479-504. doi:10.5664/jcsm.6506
  3. Epstein LJ, Kristo D, Strollo PJ Jr, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-276.
  4. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687-698. doi:10.1016/S2213-2600(19)30198-5
  5. US Preventive Services Task Force. Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. JAMA. 2022;328(19):1945-1950. doi:10.1001/jama.2022.20304

Daytime Sleepiness Scale: Your 0 to 24 Score and Sleep Apnea Signals FAQ

No. Sleep clinics use copyrighted sleepiness questionnaires licensed from their publishers, and this page does not use one of them. The eight situations here are ours, the response labels count episodes in a fixed two-week window, and the bands are educational rather than validated. A clinic will ask you to fill in its own questionnaire when you are referred. What this page gives you is a record of what actually happened over two weeks, which is a more useful thing to bring to that appointment than a memory of it.

In clinical use, a sleepiness questionnaire score of 0 to 10 out of 24 is treated as the normal range, 11 to 24 as excessive daytime sleepiness, and 16 and above as severe. The bands on this page sit near those numbers for orientation, but they were validated on that questionnaire's items, not these. Treat 11 or more here as a reason to talk to a clinician, and any drowsy driving as a reason on its own.

No. The American Academy of Sleep Medicine guideline states that questionnaires, including this one, must not be used to diagnose sleep apnea or to rule it out. They organize symptoms so a clinician can decide whether to order a home sleep apnea test or an in-laboratory study. Sleepiness together with loud snoring or witnessed pauses in breathing is the combination that justifies testing.

A small device worn for one or two nights at home that records airflow, breathing effort, oxygen level and usually heart rate. It is the first-line test for adults whose history suggests moderate to severe sleep apnea and who have no other complicating sleep or heart condition. If it is negative or inconclusive and the suspicion remains, the guideline advises an overnight polysomnography in a sleep laboratory.

Sleep that is long but broken, as in sleep apnea or periodic limb movements, sedating medicines such as some antihistamines, antidepressants and pain medicines, alcohol in the evening, an irregular schedule or shift work, depression, and less commonly narcolepsy or idiopathic hypersomnia. A two-week sleep diary and a medicine review with a clinician sort most of these before any test is needed.

Yes. Your answers and the numbers you enter are scored in your browser and are never sent to us. They stay in this browser tab so you can return to your result, and closing the tab clears them. The only thing the page sends us is a counts-only event: which test was started or completed, the result band and the headline number, with no answers, no entered values and no account. There is nothing to sign up for.

Find clinics that test for sleep apnea properly

Browse US clinics offering sleep apnea treatment. Look for ones that order a home sleep apnea test or polysomnography before treating, have physician oversight, repeat the assessment after starting CPAP or an oral appliance, and explain the alternatives. A listing on Regenerated.com is not an endorsement.

Browse sleep apnea treatment clinics

A listing is not a treatment endorsement. Read each clinic's published checks and talk to your clinician before starting any treatment.

Important: This scale is an educational screening tool with original items and our own educational bands. It is not the licensed questionnaire a sleep clinic uses, not a diagnosis of sleep apnea or any sleep disorder, and not a treatment recommendation. Only a clinician, with a sleep history and where appropriate a sleep study, can make that assessment. Do not drive if you are fighting sleep. If your symptoms are severe or sudden, seek urgent medical care.