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B-PSQI-Version 2

The document is a sleep habits questionnaire designed to assess an individual's usual sleep patterns over the past month. It includes questions about bedtimes, wake times, sleep duration, sleep disturbances, and overall sleep quality. The form is intended for non-commercial educational and research purposes, with licensing information available for commercial use.

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carla369carla8
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154 views1 page

B-PSQI-Version 2

The document is a sleep habits questionnaire designed to assess an individual's usual sleep patterns over the past month. It includes questions about bedtimes, wake times, sleep duration, sleep disturbances, and overall sleep quality. The form is intended for non-commercial educational and research purposes, with licensing information available for commercial use.

Uploaded by

carla369carla8
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

B-PSQI

ID ___ ___ ___ ___ ___ ___ Date ___ ___ / ___ ___ / ___ ___ Time ________ AM / PM
m m d d y y

INSTRUCTIONS:
The following questions relate to your usual sleep habits during the past month only. Your answers
should indicate the most accurate reply for the majority of days and nights in the past month.
Please answer all questions.

1. During the past month, when have you usually gone to bed at night?

BED TIME ___________

2. During the past month, when have you usually gotten up in the morning?

GETTING UP TIME ___________

3. During the past month, how long has it usually taken you to fall asleep each night?

NUMBER OF MINUTES ___________

4. During the past month, how many hours of actual sleep did you get at night? (This may be
different than the number of hours you spent in bed.)

HOURS OF SLEEP PER NIGHT ___________

5. During the past month, have you had trouble sleeping because you wake up in the middle of the
night or early morning?

Not during the Less than Once or twice Three or more


past month_____ once a week_____ a week_____ times a week_____

6. During the past month, how would you rate your sleep quality overall?

Very good ___________

Fairly good ___________

Fairly bad ___________

Very bad ___________

This form may only be used for non-commercial education and research purposes. If you would like to use this instrument for commercial
purposes or for commercially sponsored research, please contact the Office of Technology Management at the University of Pittsburgh at
412-648-2206 for licensing information.

© Copyright, 2019, University of Pittsburgh. All rights reserved. Developed by Daniel J. Buysse, C. F. Reynolds, T. H. Monk, S. R.
Berman, and D. J. Kupfer of the University of Pittsburgh using National Institute of Mental Health Funding.

Sancho-Domingo C, Carballo JL, Coloma-Carmona A, Buysse DJ: Psychological Assessment, 33(2):111–121, 2021.

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