[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"assessment-psqi":3,"all-assessments-nav":479,"related-assessments-query":1126},{"id":4,"title":5,"body":6,"category":422,"categoryTitle":423,"clinicalCitations":424,"copyright":422,"description":431,"disclaimer":422,"downloadLink":422,"extension":432,"faqs":433,"featured":446,"i18nReady":446,"icon":422,"interpreter":447,"lastReviewed":469,"meta":470,"navigation":471,"path":472,"permissionsNote":422,"published":446,"recommendedFrequency":422,"relatedCodes":422,"relatedConditions":422,"reviewedBy":422,"seo":473,"slug":474,"stem":475,"summary":476,"takeaways":422,"timeline":422,"type":477,"usedToDiagnose":422,"__hash__":478},"assessments\u002Fassessments\u002Fpsqi.md","PSQI: Pittsburgh Sleep Quality Index",{"type":7,"value":8,"toc":396},"minimark",[9,13,18,21,24,27,32,35,39,42,46,50,53,57,60,64,67,70,74,90,94,98,101,106,230,237,241,244,249,252,256,259,321,327,331,334,338,341,352,356,359,363,366,369,373,376,379,383,386,389,393],[10,11,12],"p",{},"The Pittsburgh Sleep Quality Index (PSQI) is a 19-item self-report measure that evaluates sleep quality and disturbances over a one-month period. Validated tool for clinical sleep assessment and research.",[14,15,17],"h2",{"id":16},"what-is-the-psqi","What is the PSQI?",[10,19,20],{},"The Pittsburgh Sleep Quality Index (PSQI) is the most widely used clinical tool for assessing sleep quality. Developed by researchers at the University of Pittsburgh in 1989, the PSQI measures subjective sleep quality over the past month across seven components.",[10,22,23],{},"The 19 self-rated items generate scores for seven components: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored 0-3, with the sum producing a global score ranging from 0-21.",[10,25,26],{},"A global PSQI score greater than 5 indicates \"poor sleep quality\" with high sensitivity and specificity for distinguishing good and poor sleepers. The PSQI is validated across clinical populations including insomnia, depression, PTSD, chronic pain, and sleep apnea.",[28,29,31],"h3",{"id":30},"screening-tool-not-diagnostic","Screening Tool, Not Diagnostic",[10,33,34],{},"The PSQI identifies poor sleep quality and its likely contributing domains. A full clinical evaluation — often including sleep studies — is required for definitive diagnosis of specific sleep disorders such as insomnia disorder or obstructive sleep apnea.",[28,36,38],{"id":37},"public-domain","Public Domain",[10,40,41],{},"The PSQI is freely available for clinical and research use. No licensing fees are required, making it accessible for widespread adoption in healthcare settings.",[14,43,45],{"id":44},"how-to-administer-the-psqi","How to Administer the PSQI",[28,47,49],{"id":48},"self-report-format","Self-Report Format",[10,51,52],{},"Patients complete the 19-item questionnaire independently, reflecting on their sleep patterns over the past month. Can be administered in-clinic or remotely via secure digital portals.",[28,54,56],{"id":55},"administration-time","Administration Time",[10,58,59],{},"Typically takes 5-10 minutes to complete. Scoring requires calculating seven component scores and summing for a global score (0-21).",[28,61,63],{"id":62},"regular-monitoring","Regular Monitoring",[10,65,66],{},"Administer at intake and every 4-8 weeks during sleep treatment. The one-month timeframe makes monthly reassessment appropriate for tracking progress.",[10,68,69],{},"Instructions ask respondents to consider their sleep over the past month, providing a detailed view of sleep patterns rather than isolated nights.",[28,71,73],{"id":72},"administration-best-practices","Administration Best Practices",[75,76,77,81,84,87],"ul",{},[78,79,80],"li",{},"Ensure patients understand the \"past month\" timeframe before starting",[78,82,83],{},"Review component scores, not just the global score, to target specific sleep issues",[78,85,86],{},"Combine with sleep diaries for detailed real-time sleep tracking",[78,88,89],{},"Consider referral to sleep specialists if PSQI > 10 with severe daytime impairment",[14,91,93],{"id":92},"psqi-scoring-interpretation","PSQI Scoring & Interpretation",[28,95,97],{"id":96},"seven-component-scores","Seven Component Scores",[10,99,100],{},"Each component is scored 0–3 (0 = no difficulty, 3 = severe difficulty). The sum of all seven component scores yields the global PSQI score (range 0–21). Higher scores reflect worse sleep quality.",[102,103,105],"h4",{"id":104},"component-breakdown","Component Breakdown",[107,108,109,128],"table",{},[110,111,112],"thead",{},[113,114,115,119,122,125],"tr",{},[116,117,118],"th",{},"#",[116,120,121],{},"Component",[116,123,124],{},"What it measures",[116,126,127],{},"Items contributing",[129,130,131,146,160,174,188,202,216],"tbody",{},[113,132,133,137,140,143],{},[134,135,136],"td",{},"1",[134,138,139],{},"Subjective sleep quality",[134,141,142],{},"Patient's overall rating of their own sleep",[134,144,145],{},"Item 6",[113,147,148,151,154,157],{},[134,149,150],{},"2",[134,152,153],{},"Sleep latency",[134,155,156],{},"Time needed to fall asleep; inability to sleep within 30 min",[134,158,159],{},"Items 2, 5a",[113,161,162,165,168,171],{},[134,163,164],{},"3",[134,166,167],{},"Sleep duration",[134,169,170],{},"Hours of actual sleep per night",[134,172,173],{},"Item 4",[113,175,176,179,182,185],{},[134,177,178],{},"4",[134,180,181],{},"Habitual sleep efficiency",[134,183,184],{},"Percentage of time in bed actually sleeping (sleep time ÷ time in bed × 100)",[134,186,187],{},"Items 1, 3, 4",[113,189,190,193,196,199],{},[134,191,192],{},"5",[134,194,195],{},"Sleep disturbances",[134,197,198],{},"Frequency of waking due to pain, bathroom use, breathing trouble, coughing, heat\u002Fcold, bad dreams, noise, or other causes",[134,200,201],{},"Items 5b–5j",[113,203,204,207,210,213],{},[134,205,206],{},"6",[134,208,209],{},"Use of sleeping medication",[134,211,212],{},"Frequency of taking prescribed or over-the-counter sleep aids",[134,214,215],{},"Item 7",[113,217,218,221,224,227],{},[134,219,220],{},"7",[134,222,223],{},"Daytime dysfunction",[134,225,226],{},"Trouble staying awake; lack of enthusiasm to complete tasks",[134,228,229],{},"Items 8, 9",[10,231,232,236],{},[233,234,235],"strong",{},"Global PSQI score > 5"," indicates poor sleep quality (sensitivity 89.6%, specificity 86.5%; Buysse et al., 1989).",[102,238,240],{"id":239},"your-estimated-sleep-night","Your Estimated Sleep Night",[10,242,243],{},"Items 1–4 together reconstruct a typical night's sleep pattern: the patient records their usual bedtime (item 1), how long it takes to fall asleep (item 2, used in Component 2), the time they wake up (item 3), and the actual hours of sleep obtained (item 4). From these, habitual sleep efficiency (Component 4) is calculated as:",[10,245,246],{},[233,247,248],{},"Sleep efficiency (%) = (hours of actual sleep ÷ hours in bed) × 100",[10,250,251],{},"For example, a patient who goes to bed at 11 pm, takes 45 minutes to fall asleep, sleeps 5.5 hours, and rises at 7 am has spent 8 hours in bed — yielding a sleep efficiency of 69%. Sleep efficiency below 85% is generally considered clinically relevant and is a key target in cognitive behavioural therapy for insomnia (CBT-I).",[102,253,255],{"id":254},"areas-to-address","Areas to Address",[10,257,258],{},"Reviewing component scores alongside the global score directs treatment. The following guide links high component scores to evidence-based intervention targets:",[107,260,261,271],{},[110,262,263],{},[113,264,265,268],{},[116,266,267],{},"Component elevated",[116,269,270],{},"Common clinical focus",[129,272,273,281,289,297,305,313],{},[113,274,275,278],{},[134,276,277],{},"Sleep latency (C2)",[134,279,280],{},"Stimulus control therapy, sleep restriction, relaxation techniques (core CBT-I modules)",[113,282,283,286],{},[134,284,285],{},"Sleep duration (C3)",[134,287,288],{},"Sleep restriction; rule out underlying mood, pain, or circadian disorder",[113,290,291,294],{},[134,292,293],{},"Sleep efficiency (C4)",[134,295,296],{},"Sleep consolidation via CBT-I; reduce time in bed while awake",[113,298,299,302],{},[134,300,301],{},"Sleep disturbances (C5)",[134,303,304],{},"Identify specific disruptor (pain, nocturia, environmental noise, nightmares); target cause directly",[113,306,307,310],{},[134,308,309],{},"Sleep medication (C6)",[134,311,312],{},"Medication taper with sleep specialist or prescriber; introduce CBT-I to replace pharmacotherapy",[113,314,315,318],{},[134,316,317],{},"Daytime dysfunction (C7)",[134,319,320],{},"Assess for comorbid depression, burnout, or suspected sleep apnea (refer if ESS also elevated)",[10,322,323,326],{},[233,324,325],{},"Clinical tip:"," Review individual component scores at every reassessment, not just the global score. Two patients can both score 9 with entirely different profiles — and entirely different intervention priorities.",[28,328,330],{"id":329},"monitoring-treatment-response","Monitoring Treatment Response",[10,332,333],{},"Track global and component scores over time to demonstrate intervention effectiveness — for example, a falling sleep latency component after stimulus control therapy, or a declining sleep medication component during a supervised taper. A meaningful reduction in global score, sustained across repeated administrations, provides the most useful signal of treatment response.",[28,335,337],{"id":336},"when-to-refer","When to Refer",[10,339,340],{},"Consider sleep specialist referral if:",[75,342,343,346,349],{},[78,344,345],{},"PSQI > 10 despite evidence-based behavioural interventions (a widely used clinical convention, not a validated severity tier)",[78,347,348],{},"High sleep disturbance score combined with reported snoring or gasping (possible obstructive sleep apnea)",[78,350,351],{},"Severe daytime dysfunction affecting occupational or social functioning",[14,353,355],{"id":354},"psqi-vs-other-sleep-assessment-tools","PSQI vs Other Sleep Assessment Tools",[10,357,358],{},"Different sleep assessment tools measure different aspects of sleep health. Understanding these differences helps you select the right tool for your clinical goals.",[28,360,362],{"id":361},"psqi-vs-isi-sleep-quality-vs-insomnia-severity","PSQI vs ISI: Sleep Quality vs Insomnia Severity",[10,364,365],{},"The PSQI is a broad-spectrum sleep assessment — use it when you need a full picture of sleep health across multiple dimensions. The ISI is focused on insomnia symptoms and their impact; use it specifically for insomnia screening and monitoring CBT-I (cognitive behavioural therapy for insomnia) treatment response. If sleep complaints are vague or you're screening for any sleep disorder, start with PSQI. If the patient clearly has insomnia, ISI is faster and more sensitive to treatment changes.",[10,367,368],{},"When to use PSQI: general sleep screening, multiple sleep concerns, research studies, detailed sleep disorder evaluation, or unclear diagnosis.",[28,370,372],{"id":371},"psqi-vs-ess-sleep-quality-vs-daytime-sleepiness","PSQI vs ESS: Sleep Quality vs Daytime Sleepiness",[10,374,375],{},"The PSQI and ESS measure opposite ends of the 24-hour sleep-wake cycle. PSQI assesses how well a patient sleeps at night; the Epworth Sleepiness Scale (ESS) assesses how sleepy they are during the day. They are complementary, not interchangeable. Use PSQI for insomnia-type complaints (\"I can't fall asleep,\" \"I wake up frequently\"). Use ESS when patients report excessive daytime sleepiness, snoring, or suspected sleep apnea — ESS scores >10 warrant sleep study referral for possible obstructive sleep apnea.",[10,377,378],{},"Use both when a patient has sleep quality complaints AND daytime sleepiness. A high ESS combined with a high PSQI suggests a disorder such as sleep apnea may be disrupting nighttime sleep and causing daytime fatigue — a pattern that warrants polysomnography (sleep study) referral.",[28,380,382],{"id":381},"psqi-vs-actigraphy-subjective-vs-objective-sleep-measurement","PSQI vs Actigraphy: Subjective vs Objective Sleep Measurement",[10,384,385],{},"PSQI and actigraphy provide different but complementary information. PSQI captures the patient's subjective experience of sleep, which directly relates to quality of life and mental health. Actigraphy provides objective data about actual sleep-wake patterns, useful when subjective reports may be unreliable (e.g., cognitive impairment, paradoxical insomnia) or when circadian rhythm data is needed. Standard practice is to use PSQI for routine screening and treatment monitoring, adding actigraphy when diagnosis is unclear, circadian disorders are suspected, or objective validation is required.",[10,387,388],{},"Patients who report poor sleep quality (high PSQI) but show normal sleep patterns on actigraphy may have paradoxical insomnia (sleep state misperception). This mismatch guides treatment toward CBT-I rather than sleep medications.",[28,390,392],{"id":391},"documenting-psqi-scores-in-clinical-notes","Documenting PSQI Scores in Clinical Notes",[10,394,395],{},"PSQI global and component scores belong in the Objective section of your clinical note. See our SOAP notes guide and Intake Notes guide for templates and examples.",{"title":397,"searchDepth":398,"depth":398,"links":399},"",2,[400,405,411,416],{"id":16,"depth":398,"text":17,"children":401},[402,404],{"id":30,"depth":403,"text":31},3,{"id":37,"depth":403,"text":38},{"id":44,"depth":398,"text":45,"children":406},[407,408,409,410],{"id":48,"depth":403,"text":49},{"id":55,"depth":403,"text":56},{"id":62,"depth":403,"text":63},{"id":72,"depth":403,"text":73},{"id":92,"depth":398,"text":93,"children":412},[413,414,415],{"id":96,"depth":403,"text":97},{"id":329,"depth":403,"text":330},{"id":336,"depth":403,"text":337},{"id":354,"depth":398,"text":355,"children":417},[418,419,420,421],{"id":361,"depth":403,"text":362},{"id":371,"depth":403,"text":372},{"id":381,"depth":403,"text":382},{"id":391,"depth":403,"text":392},null,"Sleep",[425,428],{"text":426,"link":427},"Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F2748771\u002F",{"text":429,"link":430},"Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Med Rev. 2016;25:52-73.","https:\u002F\u002Fpubmed.ncbi.nlm.nih.gov\u002F26163057\u002F","PSQI scoring — 19-item sleep quality index, global score 0–21. Score >5 indicates poor sleep quality. Validated for insomnia, depression, PTSD, chronic pain.","md",[434,437,440,443],{"question":435,"answer":436},"What does a PSQI score greater than 5 mean?","A global PSQI score greater than 5 indicates poor sleep quality. In the original validation study (Buysse et al., 1989), this threshold yielded 89.6% sensitivity and 86.5% specificity for distinguishing good sleepers from poor sleepers. A score of 0–5 is considered good sleep quality.",{"question":438,"answer":439},"Is the PSQI self-report or clinician-administered?","The PSQI is a self-report questionnaire completed by the patient. It covers the past month of sleep and takes approximately 5–10 minutes to complete. Clinician review of the component scores is recommended to guide treatment planning.",{"question":441,"answer":442},"Can the PSQI diagnose insomnia or sleep apnea?","No. The PSQI screens for poor sleep quality and identifies which domains are most affected, but it cannot diagnose a specific sleep disorder. A full clinical evaluation — including history, physical examination, and potentially a sleep study — is required for diagnosis of disorders such as insomnia disorder or obstructive sleep apnea.",{"question":444,"answer":445},"How many components does the PSQI have and what do they cover?","The PSQI has seven component scores, each rated 0–3: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The seven components sum to a global score ranging from 0 to 21.",false,{"heading":448,"scaleLabel":449,"min":450,"max":451,"start":452,"note":453,"source":454,"bands":455},"PSQI Score Interpreter","Total score",0,21,6,"19 self-rated items; 7 component scores (each 0–3) sum to a global score. Higher scores indicate worse sleep quality.","Buysse et al. 1989 (PMID 2748771). Cutoff >5 per original validation (sens 89.6%, spec 86.5%). The >10 clinical referral threshold is a widely used clinical convention, not a validated severity tier. Educational reference only — not a diagnostic tool.",[456,461,465],{"min":457,"label":458,"level":459,"note":460},11,"Severely poor sleep","error","Multiple sleep domains significantly affected. Strongly consider specialist referral, structured sleep assessment (e.g., sleep study), and evidence-based treatment such as CBT-I.",{"min":452,"label":462,"level":463,"note":464},"Poor sleep quality","warning","Global score >5 indicates poor sleep quality per validated threshold. Review component scores to identify specific domains for intervention (e.g., sleep latency, efficiency, daytime dysfunction).",{"min":450,"label":466,"level":467,"note":468},"Good sleep quality","success","Score of 0–5. No clinical sleep complaint indicated by this screening. Routine reassessment at follow-up is appropriate if sleep concerns arise.","2026-06-03",{},true,"\u002Fassessments\u002Fpsqi",{"title":5,"description":431},"psqi","assessments\u002Fpsqi","19-item self-report measure of sleep quality over the past month. Seven component scores yield a global PSQI score; >5 indicates poor sleep quality. 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