Questionnaire
PSQI
Pittsburgh Sleep Quality Index
The most-used measure of subjective sleep quality over the past month — 19 items, 7 component scores.
What it measures
Sleep quality and disturbance over the prior month. Seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medications, daytime dysfunction. Each scored 0–3; total 0–21. Higher is worse.
Mechanism
Why moving this marker matters
Captures dimensions that single-night wearable tracking misses — perceived restfulness, medication use, daytime consequences. Useful for tracking treatment response over weeks.
Guideline targets
What major guidelines recommend
Buysse 1989 validation
Global score >5 indicates poor sleep quality
How to measure
The test, where to get it, when to repeat
Method
Self-administered, ~5–10 minutes. Mixed numeric (hours slept, time taken to fall asleep) and Likert items.
Where
Public domain; widely used in sleep research and clinical trials.
Typical cost
Free.
Fasting
Not required
When to test
AASM 2014
Used in clinical sleep evaluation and CBT-i outcomes tracking.
Where to score
Completing this questionnaire
Self-administered — your GP or mental-health professional can confirm scoring and discuss results.
The instrument
Items shown for reference
Validated questionnaires are shown here as reference. Read each item and count your own answers — Healicus does not compute or store a score. This keeps the page on the educational side of the EU MDR line; the instrument itself remains the validated tool.
- 1
Usual bedtime over the past month
Numeric — used in latency calculation
- 2
How long (minutes) to fall asleep each night
Numeric — combined with item below for sleep latency component
- 3
Usual wake time over the past month
Numeric — used in duration calculation
- 4
How many hours of actual sleep per night
Numeric — sleep duration component
- 5
How often: cannot get to sleep within 30 minutes
0 (not in past month) — 3 (≥3 times/week)
- 6
How often: wake up in the middle of the night or early morning
0 — 3
- 7
How often: have to get up to use the bathroom
0 — 3
- 8
How often: cannot breathe comfortably
0 — 3
- 9
How often: cough or snore loudly
0 — 3
- 10
How often: feel too cold or too hot
0 — 3
- 11
How often: have bad dreams
0 — 3
- 12
How often: have pain
0 — 3
- 13
Overall sleep quality during the past month
0 (very good) — 3 (very bad)
- 14
How often used sleep medication (prescription or over-the-counter)
0 — 3
- 15
How often had trouble staying awake while driving, eating, or socially active
0 — 3
- 16
How much of a problem has it been to keep up enthusiasm to get things done
0 — 3
Scoring (do this yourself)
Each of the seven component scores is calculated from one or more items (formula on the original Buysse 1989 instrument). Sum the seven component scores for the global PSQI score (0–21). Buysse 1989: a global score >5 distinguishes 'poor' from 'good' sleepers with ~89% sensitivity and ~87% specificity. Computing the seven components by hand from the items is the standard workflow.
If you prefer an interactive calculator, the published MDCalc tool is available here ↗ — operated and maintained by a third party.
Context
Reading the numbers
Useful for trend tracking over weeks. Less useful for acute monitoring (use wearable sleep efficiency for that).
Caveats
Recall bias is real — subjective sleep recall over 30 days is imperfect.
Practices
What's been shown to influence this marker
CBT-i (cognitive behavioural therapy for insomnia)
Program·First-line treatment for chronic insomnia per the AASM. More effective than sleeping pills long-term.
Why
CBT-i combines stimulus control, sleep restriction, and cognitive restructuring across 4-8 sessions. The American Academy of Sleep Medicine 2021 clinical practice guideline rates it a STRONG recommendation for chronic insomnia disorder in adults — stronger than any pharmacological treatment.
The program
- 1
Start a daily sleep diary — bedtime, wake time, awakenings.
- 2
Calculate your average sleep efficiency (sleep / time-in-bed × 100%).
- 3
Sleep restriction: shrink your time-in-bed to match average sleep, then grow as efficiency rises.
- 4
Stimulus control: bed = sleep only. Out of bed if not asleep within ~20 minutes.
- 5
Cognitive restructuring: address sleep-effort and catastrophising thoughts.
- 6
Maintenance phase: continue diary, expect occasional regressions.
Practical
Cadence
4-8 weekly sessions plus daily sleep diary
What you'll need
Insomnia ≥3 months. Find a CBT-i provider (BSM-trained psychologist) or digital programme (Sleepio, Somryst).
Ideal for
Anyone with insomnia lasting more than three months.
Markers this may influence
Evidence
Sleep regularity
Habit·Hit the same bedtime within a 30-minute envelope. Stronger mortality signal than total hours slept.
Why
Cohort studies of older adults consistently show that going to bed and waking at consistent times — within a roughly 30-minute window — predicts mortality risk independent of how many hours someone sleeps. The body's circadian system entrains to expected timing; irregularity creates a low-grade jet-lag effect day after day.
Slot in your day
How to do it
How
Pick a target bedtime. Hold it within ±30 minutes, including weekends, for 4 weeks. Pair with morning sunlight within an hour of waking.
Ideal for
Anyone with shifting work hours or weekend social rhythms.
Sticking with it
Pick the bedtime that's actually possible 6 nights a week, not the aspirational one.
Markers this may influence
Evidence
See also
Related markers
Take to your physician
Worth discussing
- If your global score is consistently >5, what specific sleep disturbance pattern is most prominent.
- Whether CBT-i, sleep apnea workup, or other approach is appropriate.
- How sleep quality fits into your overall health picture.
Sources
Cited literature
Edited by Carl Pöhl, MD · Healicus editorial
Last reviewed May 2026
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