How sleepy are you?

Aug 26 2010 Published by under [Medicine&Pharma]

I've been reading a terrific book called The Twenty-four Hour Mind by Dr. Rosalind Cartwright.  Dr. Cartwright is one of the giants of sleep research, and for years ran the sleep program at my medical school.  But this isn't a book of simply parochial interest.  It's a fascinating longitudinal history of sleep research in the U.S., a history that I'd guess many physicians know little about.  I hope to get a full review up sometime soon. (I received a free copy of the book from the publisher at my request.)

Anyway, I've been thinking about sleepiness a lot lately, and I'd like to share a fun little tool with you.  The Epworth Sleepiness Scale is a commonly used tool to evaluate---you guessed it---sleepiness.  A high score may indicate a severe sleeping disorder, one that puts the patient at risk not only for medical problems such as hypertension, but also decreased work performance, and auto accidents.  One of the most common sleep disorders is "obstructive sleep apnea", an easily diagnosed and treated problem.  The Epworth scale is not a test for sleep apnea, but a high score may indicate a serious sleep problem of one sort or another, depending on a number of factors.  Try it.

11 responses so far

  • Tsu Dho Nimh says:

    Interesting, but being able to take a real afternoon nap shouldn't count against me, should it?
    That and my "if I'm not driving, I'm sleeping through this" response to planes and car trips puts me at a 12 on this scale.

    Not hypertensive, not at all, just able to shut down and snooze when circumstances allow.

  • CyberLizard says:

    Sounds fascinating. A few weeks ago I finally drug myself in to a sleep clinic. My score on the Epworth Sleepiness Scale was around 20. I was falling asleep at stoplights while driving, during phone calls, reading to my kids... not fun. They determined I had severe apnea. I was averaging 60 events per minute, some lasting as long as 66 seconds! My blood oxygen was getting down to 84%. Since I've started with the CPAP machine, things have been much, much better. I'm still trying to figure out how and when to sleep since my habits have been skewed by 30+ years of corrupted sleep. It's a weird feeling to not know what normal is.

  • Dianne says:

    My score was 11 (rounding up whenever I was uncertain of which number to pick), which may have to do with my being up still at 11:30 pm when I need to get up at 7 tomorrow. My score during residency was an easy 20, but that was iatrogenic. Apparently, I don't learn from experience.

  • WcT says:

    19 before call, and 23 postcall, 10 when I'm not on the horrible rotation I'm on now.
    Did I mention I've just been taking care of patients for the past 30 hours?

  • Dianne says:

    Did I mention I’ve just been taking care of patients for the past 30 hours?

    I thought they'd finally made that illegal.

  • James Sweet says:

    That actually made me feel better about how much sleep I'm getting. I scored pretty low for situation-normal, though there have been times recently I would have scored quite high for a few days in a row (I have an 18-month-old, so...)

  • WcT says:

    The party line is 24 hours of active patient care and 6 hours to wrap things up. that means i stop admitting after 24, and another intern is on the service at the 24 hour mark. I don't get to go home and dictate for that last 6, it's rounds, and some active issues wrapup. I haven't had to code anyone or do procedures or critical care after the 24 hour mark, but I'm not sitting on my thumbs while someone else does all the medicine.

  • D. C. Sessions says:

    Some things don't run in families (score: 1) but that's no excuse.

    In particular, sleep apnea is a hot topic for me despite having enviable BP and zilch for sleepiness because it's probably the #1 reason my children grew up without a grandfather.

    Take it seriously.

  • Nora Streed says:

    I am very familiar with this little instrument; I take it every three months or so when I visit the sleep team. I generally score about 20 (which was my score just now), even while "successfully" medicated. I have narcolepsy and some kind of circadian rhythm sleep disorder.

    Seriously - if your score is above 9 or 10, get it checked out. It has made a huge difference in my life to be diagnosed and treated. It's not curable, but it can be managed to some extent. It is not unusual for people to be undiagnosed or incorrectly diagnosed for many years while suffering from sleep disorders.

    I was first evaluated in childhood (doc told my mother to stop letting me read so much, and I am forever grateful to her for ignoring that advice). In high school and college I fell asleep nearly every day in classes. Some instructors joked about it; others encouraged medical intervention, and many (alas) were insulted and annoyed. It has been an employment issue (yes, I have been fired for falling asleep in meetings etc.), and it makes certain kinds of work extremely difficult or impossible. Like anything that involves sitting still, or being punctual. Or, obviously, driving.

    Fairly recently narcolepsy was added to the conditions covered under the Americans with Disabilities Act. That is probably the only reason I am still employed 🙂

  • Suzie B says:

    The Epworth is more reliable on a population level than on an individual level.

  • spit says:

    Nora -- I could have written your post, except that I still lack an actual diagnosis (unless one considers "idiopathic hypersomnia" to actually be a diagnosis -- better than nothing, since it allows me some medication to manage my symptoms for now).

    Actually, to be honest, I've hit the point where if one more doctor hands me another Epworth Sleepiness Scale, I'm tempted to throw it at him/her. Look, folks, I'm really bloody sleepy, it's around 20 every time you make me do this thing. No, I can't usually sit quietly and read a book, and yes, I do sometimes fall asleep in the middle of conversat.... zzzzz."

    Diagnosing these things is a tricky business, and I do suspect that over time as primary doctors and some specialists start paying better attention to sleep issues, we'll find that a whole lot of people have primary sleep disorders who have been shuffled into all sorts of miscellaneous other diagnoses. People with narcolepsy are misdiagnosed with primary depression with frightening frequency -- and it makes sense, given the symptoms, especially if there's mild cataplexy ("doctor, I know tests make me look healthy, but I just feel so drowsy and crappy all the time, even though I do get enough sleep! Oh, and I keep having all this weird muscle weakness when I feel emotional!" )

    Also: apnea is a really major problem, and I don't want to minimize it for a second, but there are a whole host of sleep issues out there. Most of the sleep specialists I've seen started out as pulmonary guys, which makes sense for apnea, but a lot of them have zero real background in neurology. IF you're lucky enough to have a primary doctor who recognizes abnormal drowsiness and thinks, hey, maybe a sleep disorder, and IF you're lucky enough to go to a sleep specialist who does more than just test you for apnea and shrug you off back to your primary doctor if that comes up negative, then you've still got some hairy, weird, oddly politically-loaded diagnostic processes in front of you. I only bring this up so that somebody who does get something high on the ESS, but doesn't have apnea, doesn't just give up on sleep as a possible problem. I've had to fight -- as well as a super sleepy person can -- to stay on the radar the whole way through, though I do finally have a sleep doctor who takes me seriously.

    We have a lot of work to do understanding this stuff, getting doctors to understand it (I've been given flat misinformation by several), and trying to find some really meaningful treatment, even if it has to remain symptom management.