Rate Your Insomnia Severity

Insomnia Severity Questionnaire

Please rate the severity of your CURRENT insomnia problems (over the past 2 weeks). Use the following scale to choose the most appropriate number for each situation:

Situation	Rate Severity 0-4
Answer the first three questions with: 0 = No Problem, 1 = Mild, 2 = Moderate Problem, 3 = Severe, 4 = Very Severe
Difficulty falling asleep
Difficulty staying asleep
Problem waking up too early
Answer the next question with: 0 = Very Satisfied, 1 = Somewhat Satisfied, 2 = Moderately Satisfied, 3 = Dissatisfied, 4 = Very Dissatisfied
How SATISFIED/dissatisfied are you with your CURRENT sleep pattern?
Answer the next question with: 0 = Not at all Interfering, 1 = A Little, 2 = Somewhat, 3 = Much, 4 = Very Much Interfering
To what extent does this sleep problem INTERFERE with your daily functioning (e.g. daytime fatigue, ability to function at work/daily chores, concentration, memory, mood) CURRENTLY?
Answer the next question with: 0 = Not at all Noticeable, 1 = A Little, 2 = Somewhat, 3 = Much, 4 = Very Much Noticeable
How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?
Answer the next question with: 0 = Not at all Worried, 1 = A Little, 2 = Somewhat, 3 = Much, 4 = Very Much Worried
How WORRIED/distressed are you about your sleep problem?

Scoring Information
1 - 7	You do not show insomnia symptoms that are outside the normal range. However this does not rule out the possibility of an underlying sleep disorder.
8 - 14	Mild insomnia. A consultation with a sleep specialist is recommended.
15 - 21	Moderate insomnia. A consultation with a sleep specialist is highly recommended.
22‐28	Severe insomnia. A consultation with a sleep specialist is strongly recommended.

* NOTE: This survey/test and its results are not medical advice, and should not be used as a substitute for seeking a medical opinion from a physician.