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Pittsburgh Sleep Quality Index (PSQI) questionnaire

Name:
ID#:		Date:		Age:
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, when have you usually gone to bed at night? USUAL BED TIME ____________________
During the past month, how long (in minutes) has it usually take you to fall asleep each night? NUMBER OF MINUTES ____________________
During the past month, when have you usually gotten up in the morning? USUAL GETTING UP TIME ____________________
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 spend in bed.) HOURS OF SLEEP PER NIGHT ____________________
INSTRUCTIONS: For each of the remaining questions, check the one best response. Please answer all questions.
During the past month, how often have you had trouble sleeping because you...	Not during the past month	Less than once a week	Once or twice a week	Three or more times a week
(a) ...cannot get to sleep within 30 minutes
(b) ...wake up in the middle of the night or early morning
(c) ...have to get up to use the bathroom
(d) ...cannot breathe comfortably
(e) ...cough or snore loudly
(f) ...feel too cold
(g) ...feel too hot
(h) ...had bad dreams
(i) ...have pain
(j) Other reason(s), please describe:
How often during the past month have you had trouble sleeping because of this?
	Very good	Fairly good	Fairly bad	Very bad
During the past month, how would you rate your sleep quality overall?
	Not during the past month	Less than once a week	Once or twice a week	Three or more times a week
During the past month, how often have you taken medicine (prescribed or "over the counter") to help you sleep?
During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?
	No problem at all	Only a very slight problem	Somewhat of a problem	A very big problem
During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done?
	No bed partner or roommate	Partner/roommate in other room	Partner in same room, but not same bed	Partner in same bed
Do you have a bed partner or roommate?
If you have a roommate or bed partner, ask him/her how often in the past month have you had...	Not during the past month	Less than once a week	Once or twice a week	Three or more times a week
(a) ...loud snoring
(b) ...long pauses between breaths while asleep
(c) ...legs twitching or jerking while you sleep
(d) ...episodes of disorientation or confusion during sleep
(e) ...other restlessness while you sleep; please describe
(e) ...other restlessness while you sleep; please describe

Reproduced from: Buysse DJ, Reynolds CF III, Monk TH, et al. The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research. Psychiatry Res 1989; 28:193. Illustration used with the permission of Elsevier Inc. All rights reserved.

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