Insomnia Severity Index (ISI)

Insomnia Severity Index
Name

First NameLast Name
Date

MonthDayYear
Date
Today, do you or would you have any difficulty at all with:

Please provide an answer for each activity.

Please rate the current (i.e., last 2 weeks) SEVERITY of your insomnia problem(s).

How SATISFIED/dissatisfied are you with your current sleep pattern?
To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.).
How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?
How WORRIED/distressed are you about your current sleep problem?
Guidelines for Scoring/Interpretation:

Add scores for all seven items (1a+1b+1c+2+3+4+5) = _____

Total score ranges from 0-28

0 - 7 = No clinically significant insomnia

8 - 14 = Subthreshold insomnia

15 - 21 = Clinical insomnia (moderate severity)

22 - 28 = Clinical insomnia
Total Score
Should be Empty:

Insomnia Severity Index