Insomnia Severity Index
For each question, please CIRCLE the number that best describes your answer.
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. Problem 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)
Print out your completed Insomnia Severity Index, along with the Guidelines for Scoring/Interpretation, to show to your health care provider.
Used with permission from Charles M. Morin, Ph.D., Université Laval
