How to Complete the Assessment
Please read each item carefully and choose the response that best describes your sleep patterns over the last 2 weeks. Your choices will remain strictly confidential and will be used to generate your personalized feedback report.
1. Please rate the current (last 2 weeks) SEVERITY of your insomnia problem(s):
Difficulty falling asleep
Difficulty staying asleep
Problem waking up too early
How SATISFIED/dissatisfied are you with your current sleep pattern?
To what extent do you consider your sleep problem to INTERFERE with your daily functioning?
e.g., daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.
How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?
How WORRIED/distressed are you about your current sleep problem?
8If you checked any problems, how difficult have they made it for you to do your work, take care of things at home, or get along with other people?
If you checked any of the sleep problems above, how much did they impact your daily life?
Important Notice & Disclaimer
This self-check is an educational wellness screening tool designed to help you evaluate your sleep patterns and sleep quality over the last two weeks.
Please keep in mind:
- This tool does not constitute a clinical diagnosis or medical evaluation.
- Getting a higher score does not mean you have a diagnosed medical or psychiatric condition.
- Only a licensed medical professional or mental health expert can diagnose clinical concerns.
If you are experiencing severe physical or emotional distress, please seek medical evaluation or connect with emergency services.