Insomnia Severity Index

Full Name(Required)

Your Email Address(Required)

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

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

Difficulty falling asleep

None

Mild

Moderate

Severe

Very Severe

Difficulty staying asleep

None

Mild

Moderate

Severe

Very Severe

Problems waking up too early

None

Mild

Moderate

Severe

Very Severe

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

Very Satisfied

Satisfied

Moderately Satisfied

Dissatisfied

Very Dissatisfied

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

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

Not at all Worried

A Little

Somewhat

Much

Very Much Worried

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

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)