The Insomnia Severity Index has seven questions. The seven answers are added up to get a total score and it shows where your sleep difficulty fits.

For each question, please CHOOSE the number that best describes your answer.

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

1. Difficulty falling asleep *

• 0 (None)
• 1 (Mild)
• 2 (Moderate)
• 3 (Severe)
• 4 (Very Severe)

2. Difficulty staying asleep *

• 0 (None)
• 1 (Mild)
• 2 (Moderate)
• 3 (Severe)
• 4 (Very Severe)

3. Problems waking up too early *

• 0 (None)
• 1 (Mild)
• 2 (Moderate)
• 3 (Severe)
• 4 (Very Severe)

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

• 0 (Very Satisfied)
• 1 (Satisfied)
• 2 (Moderately Satisfied)
• 3 (Dissatisfied)
• 4 (Very Dissatisfied)

5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? *

• 0 (Not At All Noticeable)
• 1 (A Little)
• 2 (Somewhat)
• 3 (Much)
• 4 (Very Much Noticeable)

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

• 0 (Not At All Worried)
• 1 (A Little)
• 2 (Somewhat)
• 3 (Much)
• 4 (Very Much Worried)

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? *

• 0 (Not At All Interfering)
• 1 (A Little)
• 2 (Somewhat)
• 3 (Much)
• 4 (Very Much Interfering)

Name *

Please fill in your name and email so we can send back your Insomnia Severity Score and our tips to improve your sleep.

Email *

Any comments or suggestions are welcome (optional):

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