The Insomnia Severity Index has seven questions. The seven answers are added up to get a total score. When you have your total score, look at the ‘Guidelines for Scoring/Interpretation’ at the bottom of the Insomnia Severity Index page to see where your sleep difficulty fits. Print out a copy of your completed Insomnia Severity Index to take to your health care provider.
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