Pittsburgh Sleep Quality Index

 

Instructions:

The following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month. Please answer all questions.

 

During the past month...

What time have you usually gone to bed at night?
How long (in minutes) has it usually taken you to fall asleep each night?
What time have you usually gotten up in the morning?
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...

Couldn't get to sleep within 30 minutes?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Woke up in the middle of the night or early morning?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Had to get up to use the bathroom?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Couldn't breathe comfortably?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Coughed or snored loudly?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Felt too cold?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Felt too hot?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Had bad dreams?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Had pain?	Never Less than Once a Week Once or Twice a Week Three or More a Week
Other:	Never Less than Once a Week Once or Twice a Week Three or More a Week

 

During the past month...

How would you rate your sleep quality overall?	Very Good Fairly Good Fairly Bad Very Bad
How often have you taken medicine to help you sleep (prescribed or "over the counter")?	Never Less than Once a Week Once or Twice a Week Three or More a Week
How often have you had trouble staying awake while driving, eating meals, or engaging in social activity?	Never Less than Once a Week Once or Twice a Week Three or More a Week
How much of a problem has it been for you to keep up enough enthusiasm to get things done?	Not at All A Slight Problem Somewhat of a Problem A Very Big Problem

 

Do you have...

A roommate?

No Yes, in Another Room Yes, in Same Room Yes, in Same Bed