CBT-I Assessment Module
Cognitive Behavioural Therapy for Insomnia
Screening
Before we begin, please answer the following questions to determine if self-guided CBT-I is appropriate for you.
⚠️ Important Notice
Based on your responses, self-guided CBT-I may not be appropriate for you at this time. We strongly recommend that you consult with a healthcare professional or qualified sleep specialist before beginning any insomnia treatment program.
A healthcare provider can assess your individual circumstances and provide personalised guidance on the most suitable treatment approach for your needs.
Insomnia Severity Index (ISI)
Step 1 of 3
Please rate the current (i.e., last 2 weeks) severity of your insomnia problems.
1. Difficulty falling asleep
2. Difficulty staying asleep
3. Problems waking up too early
4. How satisfied/dissatisfied are you with your current sleep pattern?
5. How noticeable to others do you think your sleep 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?
Pittsburgh Sleep Quality Index (PSQI)
Step 2 of 3
The following questions relate to your usual sleep habits during the past month only.
1. During the past month, what time have you usually gone to bed?
2. During the past month, how long (in minutes) has it taken you to fall asleep each night?
3. During the past month, what time have you usually got up in the morning?
4. During the past month, how many hours of actual sleep did you get at night?
5a. Cannot get to sleep within 30 minutes
5b. Wake up in the middle of the night or early morning
5c. Have to get up to use the bathroom
5d. Cannot breathe comfortably
5e. Cough or snore loudly
5f. Feel too cold
5g. Feel too hot
5h. Have bad dreams
5i. Have pain
5j. Other reason(s)
6. During the past month, how often have you taken medicine (prescribed or over-the-counter) to help you sleep?
7. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?
8. During the past month, how much of a problem has it been for you to keep up enthusiasm to get things done?
9. During the past month, how would you rate your sleep quality overall?
Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16)
Step 3 of 3
Please indicate to what extent you agree or disagree with each statement. Use the scale from 0 (strongly disagree) to 10 (strongly agree).
1. I need 8 hours of sleep to feel refreshed and function well during the day.
2. When I don't get the proper amount of sleep on a given night, I need to catch up on the next day by napping or on the next night by sleeping longer.
3. I am concerned that chronic insomnia may have serious consequences on my physical health.
4. I am worried that I may lose control over my abilities to sleep.
5. After a poor night's sleep, I know that it will interfere with my daily activities on the next day.
6. In order to be alert and function well during the day, I believe I would be better off taking a sleeping pill rather than having a poor night's sleep.
7. When I feel irritable, depressed, or anxious during the day, it is mostly because I did not sleep well the night before.
8. When I sleep poorly on one night, I know it will disturb my sleep schedule for the whole week.
9. Without an adequate night's sleep, I can hardly function the next day.
10. I can't ever predict whether I'll have a good or poor night's sleep.
11. I have little ability to manage the negative consequences of disturbed sleep.
12. When I feel tired, have no energy, or just seem not to function well during the day, it is generally because I did not sleep well the night before.
13. I believe insomnia is essentially the result of a chemical imbalance.
14. I feel that insomnia is ruining my ability to enjoy life and prevents me from doing what I want.
15. Medication is probably the only solution to sleeplessness.
16. I avoid or cancel obligations (social, family) after a poor night's sleep.
Your Results
Disclaimer: This tool is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.