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Insomnia Severity Index Guide

The document provides a 7 question insomnia severity index survey to assess insomnia symptoms over the last 2 weeks. Scores are categorized as no clinically significant insomnia, subthreshold insomnia, clinical insomnia of moderate severity, or clinical insomnia of severe severity based on a total score ranging from 0 to 28.

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vtu7930
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117 views1 page

Insomnia Severity Index Guide

The document provides a 7 question insomnia severity index survey to assess insomnia symptoms over the last 2 weeks. Scores are categorized as no clinically significant insomnia, subthreshold insomnia, clinical insomnia of moderate severity, or clinical insomnia of severe severity based on a total score ranging from 0 to 28.

Uploaded by

vtu7930
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
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Insomnia Severity Index

Name : _____________________________________ Date : _________________________________

Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).

Insomnia Problem None Mild Moderate Severe Very Severe


1. Difficulty falling asleep 0 1 2 3 4
2. Difficulty staying asleep 0 1 2 3 4
3. Problems waking up too early 0 1 2 3 4

4. How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern?


Very Satisfied Satisfied Moderately Satisfied Dissatisfied Very Dissatisfied
0 1 2 3 4

5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?
Not at all
Noticeable A Little Somewhat Much Very Much Noticeable
0 1 2 3 4

6. How WORRIED/DISTRESSED are you about your current sleep problem?


Not at all
Worried A Little Somewhat Much Very Much Worried
0 1 2 3 4

7. To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime
fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY?
Not at all
Interfering A Little Somewhat Much Very Much Interfering
0 1 2 3 4

Guidelines for Scoring/Interpretation:

Add the scores for all seven items (questions 1 + 2 + 3 + 4 + 5 +6 + 7) = your total score

Total score categories:


0–7 = No clinically significant insomnia
8–14 = Subthreshold insomnia
15–21 = Clinical insomnia (moderate severity)
22–28 = Clinical insomnia (severe)

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