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Other Assessments:  GAD7   PHQ9




For each question below, please circle the number corresponding most accurately to your sleep patterns in the LAST 2 WEEKS.

For the first three questions, please rate the SEVERITY of your sleep difficulties.


Mobile/Print Version 



 NoneMildModerateSevereVery Severe
1. Difficulty falling asleep:01234
2. Difficulty staying asleep:01234
3. Problem waking up too early in the morning: 01234
SatisfiedNeutralDissatisfiedVery Dissatisfied
4. How SATISFIED/dissatisfied are you with your current sleep pattern?01234
 Not at all InterferingA Little InterferingSomewhat InterferingVery InterferingVery Much Interfering
5.  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).01234
 Not at all NoticeableA Little NoticeableSomewhat NoticeableVery NoticeableVery Much Noticeable
6. How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?01234
 Not at allA Little SomewhatVeryVery Much
7. How WORRIED/distressed are you about your current sleep problem?01234





This result suggests that there is no clinically significant insomnia at this time; if you are still concerned about your sleep, you may want to repeat this test in a few days or talk to a health-care professional about it.



This result suggests the presence of insomnia symptoms of mild to moderate severity. Although this degree of insomnia severity may not require immediate treatment, you may still want to talk to a health-care professional about your sleep (for further evaluation) or continue monitoring these symptoms to check if they worsen over time.



This result suggests that you experience insomnia symptoms of moderate severity; such symptoms are usually significant enough to warrant further evaluation and treatment. You should talk to a health-care professional about it.



This result suggests that you experience severe insomnia associated with significant impairments of daytime functioning.  You should talk to a health-care professional about additional evaluation and treatment.



© Morin, C.M. (1993, 1996, 2000, 2006). ISI – Hong Kong/English - Version of 10 Sep 15 - Mapi. ID044977 / ISI_AU2.0-last-2-weeks_eng-HK.doc.



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