Hurdle

Pittsburgh Sleep Quality Index (PSQI)

screening

Digital administration of Pittsburgh Sleep Quality Index (PSQI) to collect structured patient inputs for validated score calculation and clinical follow-up.

Pittsburgh Sleep Quality Index (PSQI)

Clinical intent

The Pittsburgh Sleep Quality Index (PSQI) consist of items 18 self-rated questions. The items are combined to form seven 'component' score, each of which has a range of 0-3 points. In all cases, a score of "0" indicates no difficulty, while a score of "3" indicates severe difficulty. The seven component scores are then added to yield one "global" score, which range of 0-21 points, "0" indicating no difficulty and "21" indicating severe difficulties in all areas.

References

[1] The Pittsburgh Sleep Quality Index (PSQI) is copyrighted by Daniel J. Buysse, M.D. Permission has been granted to reproduce the scale on this website for clinicians to use in their practice and for researchers to use in non-industry studies. For other uses of the scale, the owner of the copyright should be contacted. [2] Buysse, DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. Psychiatry Research 28:193-213, 1989

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Form preview

Interactive preview of the questionnaire. Not for clinical use. Responses are not stored.

Pittsburgh Sleep Quality Index (PSQI) Questionnaire
Please complete this questionnaire. Your responses help your clinical team assess your symptoms and monitor progress over time.
During the past month, what time have you usually gone to bed at night? (In 24 hour format)
During the past month, how long (in minutes) has it usually taken you to fall asleep each night?
During the past month, what time have you usually gotten up in the morning? (In 24 hour format)
During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spent in bed.)
During the past month, how often have you had trouble sleeping because you cannot get to sleep within 30 minutes
During the past month, how often have you had trouble sleeping because you wake up in the middle of the night or early morning?
During the past month, how often have you had trouble sleeping because you have to get up to use the bathroom?
During the past month, how often have you had trouble sleeping because you cannot breathe comfortably?
During the past month, how often have you had trouble sleeping because you cough or snore loudly?
During the past month, how often have you had trouble sleeping because you feel too cold?
During the past month, how often have you had trouble sleeping because you feel too hot?
During the past month, how often have you had trouble sleeping because you have bad dreams?
During the past month, how often have you had trouble sleeping because you have pain?
During the past month, how often have you had trouble sleeping because of other reason(s):
If you had other reason(s), please describe:
During the past month, how often have you taken medicine to help you sleep (prescribed or “over the counter”)?
During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?
During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done?
During the past month, how would you rate your sleep quality overall?