Insomnia Screening

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The Insomnia Severity Index has seven questions. The seven answers are added up to get a total score. Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).

Question
1. Do you have difficulty in falling asleep?
 
 
 
 
 
2. Do you have difficulty staying asleep?
 
 
 
 
 
3. Do you have problems waking up too early?
 
 
 
 
 
4. How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern?
 
 
 
 
 
5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?
 
 
 
 
 
6. How WORRIED/DISTRESSED are you about your current sleep problem?
 
 
 
 
 
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?
 
 
 
 
 

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