INSOMNIA SEVERITY INDEX

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Please Answer All Questions

The Insomnia Severity Index has seven questions. The seven answers are added up to get a total score. Please use the scale that follows the questions to determine your score.

Please rate the CURRENT (LAST 2 WEEKS) SEVERITY of your insomnia problem.
Use the information at the bottom of the form to determine your score.

Use the following scale to determine your score:

• Score 0 if you answered None, Very Satisfied or Not at all
• Score 1 if you answered Mild, Satisfied or A little
• Score 2 if you answered Moderate, Moderately Satisfied or Somewhat
• Score 3 if you answered Severe, Dissatisfied or Much
• Score 4 if you answered Very Severe, Very Dissatisfied or Very much