Insomnia Severity Calculator

Free Insomnia Severity Index (ISI) assessment using the clinically validated 7-question questionnaire. Measure your sleep difficulty severity, calculate ISI score (0-28), and get personalized treatment recommendations from sleep specialists.

Clinical ISI Assessment
📝 Instructions

Please answer the following 7 questions about your sleep patterns over the past 2 weeks. Rate each item by selecting the number that best describes your experience. Be honest—there are no right or wrong answers.

1
Please rate the current (i.e., last 2 weeks) SEVERITY of your insomnia problem(s):
Difficulty falling asleep:
2
Difficulty staying asleep:
3
Problem waking up too early:
4
How SATISFIED/DISSATISFIED are you with your current sleep pattern?
5
How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?
6
How WORRIED/DISTRESSED are you about your current sleep problem?
7
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.)?
Your ISI Score
15
Moderate Insomnia
0 (None) 7 14 21 28 (Severe)
Moderate Severity Level
Treatment Action Needed
4-8 wks CBT-I Duration

Your Assessment

Your ISI score indicates moderate clinical insomnia. This level of sleep disturbance warrants professional treatment. Cognitive Behavioral Therapy for Insomnia (CBT-I) is recommended as first-line treatment, with 70-80% success rate.

💊 Treatment Recommendations

  • Schedule appointment with sleep specialist or psychologist trained in CBT-I
  • Begin CBT-I program (6-8 weekly sessions, 70-80% cure rate)
  • Implement sleep restriction therapy (temporarily limit time in bed)
  • Practice stimulus control (bed = sleep only, no phones/TV)

Understanding Insomnia & ISI Scoring

Insomnia disorder is persistent difficulty falling asleep, staying asleep, or waking too early, despite adequate opportunity for sleep. It causes daytime impairment and distress. The Insomnia Severity Index (ISI) is the gold-standard self-report tool for measuring insomnia severity and treatment response.

ISI Score Interpretation

  • 0-7 points: No clinically significant insomnia
  • 8-14 points: Subthreshold insomnia (mild)
  • 15-21 points: Moderate clinical insomnia (treatment recommended)
  • 22-28 points: Severe clinical insomnia (immediate treatment required)

ISI Reliability & Validity

The ISI has been validated in thousands of studies:

  • Sensitivity: 86% (correctly identifies insomnia)
  • Specificity: 88% (correctly identifies good sleepers)
  • Test-retest reliability: 0.95 (highly consistent)
  • Treatment sensitivity: Detects 6-point improvement with CBT-I

Types of Insomnia

  • Sleep onset insomnia: Difficulty falling asleep (>30 min nightly)
  • Sleep maintenance insomnia: Frequent/prolonged night wakings
  • Early morning awakening: Waking 2+ hours before desired
  • Mixed insomnia: Combination of above (most common)

Primary vs Secondary Insomnia

  • Primary: No identifiable cause (10-15% of cases). Pure sleep disorder.
  • Secondary: Due to medical/psychiatric conditions (85-90%). Causes: anxiety (40%), depression (35%), chronic pain (25%), GERD, restless legs, medications.

Insomnia Prevalence & Impact

  • 33% adults have insomnia symptoms
  • 10-15% meet diagnostic criteria for chronic insomnia disorder
  • Women 40% more likely than men (hormonal factors)
  • Increases with age (50% of seniors affected)
  • Economic cost: $63 billion/year (USA) in productivity loss

Health Consequences

  • Mental health: 3x depression risk, 2.5x anxiety risk
  • Cardiovascular: 45% increased heart disease risk
  • Metabolic: 2x diabetes risk, weight gain
  • Cognitive: Memory impairment, 1.5x dementia risk
  • Immune: 3x infection susceptibility
  • Accidents: 2.5-4x car crash risk

CBT-I: Gold Standard Treatment

Cognitive Behavioral Therapy for Insomnia (CBT-I) is first-line treatment per American Academy of Sleep Medicine:

  • Success rate: 70-80% cure chronic insomnia
  • Duration: 6-8 weekly sessions (45-60 min each)
  • Long-term: Effects last years, unlike pills
  • No side effects: Unlike medications
  • Components: Sleep restriction, stimulus control, cognitive therapy, relaxation, sleep hygiene

CBT-I Techniques Explained

  • Sleep Restriction: Temporarily limit time in bed to match actual sleep time (builds sleep pressure). Gradually increase as efficiency improves. Paradoxically makes sleep deeper.
  • Stimulus Control: Re-associate bed with sleep. Rules: Bed = sleep/sex only. No phones, TV, reading. Leave bed if awake >20 min. Return only when sleepy.
  • Cognitive Restructuring: Challenge catastrophic thoughts (“I’ll never sleep,” “I need 8 hours”). Replace with realistic beliefs.
  • Relaxation Training: Progressive muscle relaxation, deep breathing, imagery. Reduces pre-sleep arousal.

Medication Options (Short-term Only)

  • Z-drugs (Ambien, Lunesta): 2-4 weeks max. Dependency risk, tolerance, rebound insomnia. Next-day impairment.
  • Benzodiazepines: High addiction potential. Not recommended. Increased dementia risk long-term.
  • Melatonin: 0.5-5mg effective for circadian issues (jet lag, shift work). Less effective for primary insomnia.
  • Trazodone: Off-label, sedating antidepressant. 50-100mg. Better than Z-drugs but still long-term concerns.
  • Over-the-counter: Diphenhydramine (Benadryl) causes tolerance quickly, cognitive impairment in elderly.

Sleep Hygiene Basics

  • Consistent wake time (±30 min) including weekends
  • Cool bedroom (60-67°F / 15-19°C)
  • Complete darkness (blackout curtains, remove LED lights)
  • No caffeine after 2 PM (6-8 hour half-life)
  • No alcohol 4+ hours before bed (fragments sleep)
  • Exercise daily, but finish 3+ hours before bed
  • No screens 1 hour before bed (blue light suppresses melatonin)

When to See a Doctor

  • ISI score ≥15 (moderate-severe insomnia)
  • Insomnia lasting >3 months
  • Daytime impairment (work, relationships, mood)
  • Suspected sleep apnea (snoring, gasping, witnessed pauses)
  • Restless legs syndrome symptoms
  • Using sleeping pills >2 weeks

Alternative Approaches

  • Light therapy: 10,000 lux bright light for 30 min morning (circadian rhythm disorders)
  • Acupuncture: Some evidence for efficacy, low risk
  • Mindfulness meditation: Reduces pre-sleep arousal, 58% improvement in studies
  • Exercise: 150 min/week moderate aerobic = 65% insomnia symptom reduction
  • Herbal supplements: Valerian, chamomile have weak evidence. Not FDA-regulated.