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Home
Clinic
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Sleep Studies
Dr David Cunnington
FAQs
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Registration form
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Attend Appointment
Telehealth appointment
In-clinic appointment
FAQs
Questionnaires & forms
Learn about sleep
Contact
Ph: 03 8609 0308
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)