Insomnia Severity Index mn – Vibrocise

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Vibrocise Painsomnia

Insomnia Severity Index – Please answer all questions

1. Difficulty falling asleep*
- None
- Mild
- Moderate
- Severe
- Very severe
2. Difficulty staying asleep*
- None
- Mild
- Moderate
- Severe
- Very severe
3. Problems waking up too early*
- None
- Mild
- Moderate
- Severe
- Very severe
4. How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern?*
- Very Satisfied
- Satisfied
- Moderately Satisfied
- Dissatisfied
- Very Dissatisfied
5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life?*
- Not at all noticeable
- A little
- Somewhat
- Much
- Very much noticeable
6. How WORRIED/DISTRESSED are you about your current sleep problem?*
- Not at all worried
- A little
- Somewhat
- Much
- Very much worried
7. To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY?*
- Not at all interfering
- A little
- Somewhat
- Much
- Very much interfering
Total Score*
Name*
First Last
Email address*
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Click submit to receive your insomnia severity index (sleep score) by email. To receive information explaining your score and additional tips on improving sleep, you will need to complete the double opt-in process (check your Inbox for an email from Vibrocise Painsomnia to confirm your subscription).