CBT for Insomnia: Introductory Assessment

Important Safety Screening

Cognitive Behavioural Therapy for Insomnia (CBT-I) is highly effective, but self-guided programmes are not suitable for everyone. Please answer the following questions. If you answer "Yes" to any of them, it is important to speak with a healthcare provider before proceeding with this or any other self-guided CBT-I programme.

Please check any of the following that apply to you:

I work in a high-risk job that requires alertness or operating heavy machinery or driving. I have been diagnosed with bipolar disorder or have experienced manic or hypomanic episodes. I have a seizure disorder or a history of seizures. I have significant mobility problems or am at high risk of falls. I experience severe depression, psychosis or active suicidal thoughts. I am currently taking sedative–hypnotic medication that causes excessive daytime sleepiness.

Important Recommendation
Based on your answers, a self-guided CBT-I programme may not be appropriate for you at this time. The sleep restriction component of CBT-I can cause temporary daytime sleepiness, which could pose a risk. We strongly recommend you consult with a qualified health professional (such as a GP, psychologist, or sleep specialist) to discuss your situation and determine the safest and most effective treatment path for you.

Insomnia Severity Index (ISI)

Please rate the severity of your insomnia problems over the past 2 weeks.

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. 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)?

Not at all A little Somewhat Much Very Much

6. How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?

Not at all A little Somewhat Much Very Much

7. How WORRIED/DISTRESSED are you about your current sleep problem?

Not at all A little Somewhat Much Very Much

Pittsburgh Sleep Quality Index (PSQI)

The following questions relate to your usual sleep habits during the past month only.

1. When have you usually gone to bed?

2. How long (in minutes) has it usually taken you to fall asleep each night?

3. When have you usually gotten up in the morning?

4. How many hours of actual sleep did you get at night? (This may be different than the number of hours you spent in bed).

5. During the past month, how often have you had trouble sleeping because you...

0 = Not during the past month; 1 = Less than once a week; 2 = Once or twice a week; 3 = Three or more times a week

a. Cannot get to sleep within 30 minutes

0 1 2 3

b. Wake up in the middle of the night or early morning

0 1 2 3

c. Have to get up to use the bathroom

0 1 2 3

d. Cannot breathe comfortably

0 1 2 3

e. Cough or snore loudly

0 1 2 3

f. Feel too cold

0 1 2 3

g. Feel too hot

0 1 2 3

h. Had bad dreams

0 1 2 3

i. Have pain

0 1 2 3

j. Other reason(s)

0 1 2 3

6. During the past month, how often have you taken medicine to help you sleep (prescribed or "over the counter")?

Not during past month Less than once a week Once or twice a week Three or more times a week

7. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?

Not during past month Less than once a week Once or twice a week Three or more times a week

8. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done?

No problem at all Only a very slight problem Somewhat of a problem A very big problem

9. During the past month, how would you rate your sleep quality overall?

Very good Fairly good Fairly bad Very bad

Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16)

Please rate how much you agree or disagree with the following statements. A score of 0 means you strongly disagree and a score of 10 means you strongly agree.

Your Assessment Summary

Here is a summary of your results. This information is for educational purposes and can help you understand your sleep patterns better.

Insomnia Severity Index (ISI)

Your Score: / 28

Higher scores reflect greater insomnia severity. Scores of 15 or higher suggest that insomnia is a significant clinical problem, and it is recommended to consult a healthcare professional.

Pittsburgh Sleep Quality Index (PSQI)

Your Global Score: / 21

This index measures sleep quality over a 1-month period. A global score greater than 5 is indicative of poor sleep quality.

Dysfunctional Beliefs about Sleep (DBAS-16)

Your Average Score: / 10

The following beliefs, which you rated highly (8 or more), may be specific targets for cognitive work:

Integrated Interpretation

Please Note: This assessment is not a diagnosis. It is an educational tool to provide insight into your sleep. If you have concerns about your sleep, or if your results indicate moderate-to-severe issues, we strongly encourage you to consult with a qualified sleep specialist, psychologist, or your GP to discuss a personalised treatment plan. They can help determine if a programme like CBT-I is right for you.