Insomnia Severity Index, ISI Test - the question form
Questions: 7 · 2 minutes
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1. Difficulty falling asleep.
None
Mild
Moderate
Severe
Very severe
2. Rate the severity of your sleep problem over the past two weeks: Waking up frequently.
None
Mild
Moderate
Severe
Very severe
3. Early morning awakening (waking up earlier than desired and not being able to fall asleep again) over the past two weeks.
None
Mild
Moderate
Severe
Very severe
4. How satisfied are you with your current sleep pattern?
Very satisfied
Satisfied
Moderately satisfied
Dissatisfied
Very dissatisfied
5. To what extent do you consider your sleep problem to interfere with your daily functioning (e.g., daytime fatigue, reduced ability to function at work, impaired concentration, memory, mood, etc.)?
Not at all
Slightly
Somewhat
Severely
Very much
6. To what extent do you think your sleep problem is noticeable to others and interferes with your quality of life?
Not noticeable
Slightly
A little
Severely
Very noticeable
7. How worried/distressed are you about your current sleep problem?
Not at all worried
Slightly
Somewhat
Extremely
Very worried
1. Difficulty falling asleep.
None
Mild
Moderate
Severe
Very severe
2. Rate the severity of your sleep difficulties over the past two weeks: Waking up frequently.
None
Mild
Moderate
Severe
Very severe
3. Early morning awakening with inability to return to sleep.
No
Mild
Moderate
Severe
Very severe
4. How satisfied are you with your current sleep pattern?
Very satisfied
Satisfied
Moderately satisfied
Dissatisfied
Very dissatisfied
5. To what extent do you consider your sleep problem to interfere with your daily functioning (e.g., daytime fatigue, reduced ability to function at work or during daily activities, reduced concentration, memory, mood, etc.)?
Not at all
Slightly
A little
Much
Very much
6. To what extent do you think your sleep problems are noticeable to others and interfere with your daily life?
Not noticeable
Slightly
A little
Severely
Very noticeable
7. How worried or distressed are you about your current sleep problem?
Not at all worried
A little
Somewhat
Extremely worried
Very worried