Comprehensive Sleep Quality Score
18-Question Multi-Factor Sleep Assessment — 5 Domains
The 5 Sleep Domains
This comprehensive assessment evaluates your sleep across five distinct domains, each capturing a different dimension of sleep health:
Domain 1: Sleep Duration & Timing
- What it measures: How many hours you sleep, how consistent your schedule is, how long it takes to fall asleep (sleep latency), and whether you experience social jetlag (sleeping in on weekends). These factors are critical because your circadian rhythm, the internal clock governing sleep-wake cycles, thrives on regularity.
- Why it matters: Adults need 7–9 hours of sleep for optimal health (Hirshkowitz et al., 2015). Irregular sleep schedules are associated with increased cardiovascular risk, metabolic dysfunction, and impaired cognitive performance. Sleep latency over 30 minutes is a hallmark of sleep-onset insomnia.
Domain 2: Sleep Quality & Continuity
- What it measures: How often you wake during the night, how quickly you return to sleep, early-morning awakenings, and your subjective rating of sleep quality. These items capture the fragmentation and perceived restorative value of your sleep.
- Why it matters: Fragmented sleep reduces time spent in deep slow-wave sleep and REM sleep, both of which are essential for memory consolidation, immune function, and emotional regulation. Even if total sleep time is adequate, poor continuity can lead to excessive daytime sleepiness and impaired functioning.
Domain 3: Daytime Impact
- What it measures: Daytime sleepiness, mood disturbance, cognitive impairment (concentration and memory), and reliance on caffeine. These are the downstream consequences of poor sleep that most directly affect your daily life.
- Why it matters: The true cost of poor sleep is measured during waking hours. Daytime sleepiness increases accident risk, reduces work productivity, and impairs social functioning. Sleep-related mood disturbance is bidirectional: poor sleep worsens mood, and poor mood worsens sleep, creating a vicious cycle.
Domain 4: Sleep Environment & Habits
- What it measures: The quality of your sleep environment (darkness, noise, temperature), pre-bedtime screen use, and evening consumption of caffeine or alcohol. These behavioral and environmental factors are among the most modifiable influences on sleep quality.
- Why it matters: Light exposure from screens suppresses melatonin production, delaying sleep onset. Caffeine has a half-life of 5–7 hours, meaning even afternoon consumption can disrupt sleep. Alcohol may help initiate sleep but fragments the second half of the night. Optimizing these habits is the foundation of sleep hygiene.
Domain 5: Sleep Disorders Risk
- What it measures: Symptoms associated with common sleep disorders, including snoring and breathing pauses (obstructive sleep apnea), restless legs syndrome, and parasomnia symptoms (vivid nightmares, dream enactment). These are red flags that warrant medical evaluation.
- Why it matters: Untreated sleep apnea increases risk of hypertension, heart disease, stroke, and type 2 diabetes. Restless legs syndrome affects 5–10% of adults and can severely disrupt sleep onset. REM sleep behavior disorder (acting out dreams) may be an early marker of neurodegenerative conditions. Identifying these symptoms early enables timely diagnosis and treatment.
Sleep Science
Understanding how sleep works can help you appreciate why each domain of this assessment matters.
Sleep Stages:
- NREM Stage 1 (N1): The transition between wakefulness and sleep, lasting 1–5 minutes. Brain waves slow from alpha to theta frequencies. You may experience hypnagogic hallucinations or the sensation of falling.
- NREM Stage 2 (N2): Light sleep comprising about 50% of total sleep time. Characterized by sleep spindles and K-complexes, which are thought to play a role in memory consolidation and protecting sleep from external disruption.
- NREM Stage 3 (N3 / Slow-Wave Sleep): Deep sleep characterized by delta waves. This is the most restorative stage, essential for physical recovery, immune function, and growth hormone release. It is hardest to wake someone from this stage. Deep sleep decreases with age, which partly explains why older adults often report lighter, less refreshing sleep.
- REM Sleep: Characterized by rapid eye movements, muscle atonia (temporary paralysis), and vivid dreaming. REM sleep is critical for emotional processing, memory consolidation, and creative problem-solving. REM periods grow longer as the night progresses, with the longest periods occurring in the final hours of sleep.
Circadian Rhythm:
- Your circadian rhythm is a roughly 24-hour internal clock regulated by the suprachiasmatic nucleus (SCN) in the hypothalamus. It is primarily synchronized by light exposure, particularly blue light wavelengths.
- The circadian rhythm controls the timing of melatonin release (beginning approximately 2 hours before habitual bedtime), body temperature fluctuations (lowest around 4–5 AM), and cortisol patterns (peaking shortly after waking).
- Disruption of circadian rhythm (through shift work, jet lag, or irregular schedules) is associated with increased risk of obesity, depression, cardiovascular disease, and certain cancers.
Sleep Drive (Homeostatic Sleep Pressure):
- Sleep drive is the accumulation of adenosine in the brain during waking hours. The longer you are awake, the stronger the pressure to sleep becomes.
- Caffeine works by blocking adenosine receptors, temporarily masking sleep pressure without actually reducing it.
- Napping can partially discharge sleep drive, which is why long or late-afternoon naps can make it harder to fall asleep at night.
Chronotypes:
- Chronotype refers to your natural preference for sleep timing. “Morning larks” naturally wake early and feel most alert in the morning; “night owls” prefer later bedtimes and peak later in the day.
- Chronotype is partly genetic and shifts across the lifespan: children tend to be morning types, adolescents shift toward evening types, and older adults shift back toward morning types.
- Forcing yourself to sleep against your natural chronotype (e.g., a night owl with an early work schedule) can lead to chronic sleep restriction and social jetlag.
Improving Sleep Quality
Evidence-based recommendations organized by domain. Focus on the domains where your score was highest (worst).
Improving Duration & Timing:
- Set a fixed wake time 7 days a week — this is the single most powerful anchor for your circadian rhythm. Varying your wake time by more than 30 minutes disrupts your internal clock.
- Calculate your ideal bedtime by counting back 7.5–8 hours from your wake time. Adjust based on how you feel after 2 weeks.
- If you take more than 20 minutes to fall asleep, get out of bed and do something relaxing in dim light until you feel sleepy. This is called stimulus control therapy.
- Minimize social jetlag by keeping weekend sleep times within 1 hour of weekday times.
Improving Quality & Continuity:
- Avoid checking the clock when you wake at night — clock-watching increases anxiety and makes it harder to return to sleep.
- If nighttime awakenings are frequent, consider sleep restriction therapy under professional guidance: temporarily limit time in bed to build sleep pressure and consolidate sleep.
- Practice relaxation techniques (progressive muscle relaxation, 4-7-8 breathing, or body scan meditation) to facilitate sleep onset and return to sleep.
- Evaluate whether medical conditions (pain, nocturia, acid reflux) are contributing to awakenings and discuss with your healthcare provider.
Reducing Daytime Impact:
- Get bright light exposure (ideally sunlight) within 30 minutes of waking to suppress residual melatonin and boost alertness.
- If you must nap, limit naps to 20–30 minutes before 2 PM to avoid disrupting nighttime sleep.
- Regular exercise (150+ minutes/week of moderate activity) improves sleep quality and reduces daytime sleepiness, but complete vigorous exercise at least 3–4 hours before bedtime.
- Reduce caffeine gradually if you rely heavily on it — sudden cessation can cause withdrawal headaches and fatigue.
Optimizing Environment & Habits:
- Keep your bedroom temperature between 65–68°F (18–20°C). A cool environment facilitates the natural drop in core body temperature needed for sleep onset.
- Use blackout curtains or a sleep mask to block light. Even small amounts of light can suppress melatonin and reduce deep sleep.
- Establish a “screen curfew” at least 30–60 minutes before bed. Replace screens with reading, gentle stretching, journaling, or audio content.
- Stop caffeine by noon and limit alcohol to at least 3–4 hours before bedtime.
Addressing Sleep Disorder Symptoms:
- If you score high in Domain 5, consult a sleep medicine specialist. Many sleep disorders are highly treatable but require proper diagnosis.
- For snoring or suspected sleep apnea, a home sleep test or in-lab polysomnography can confirm the diagnosis. Treatment options include CPAP therapy, oral appliances, positional therapy, and in some cases surgery.
- For restless legs, iron levels should be checked (ferritin below 50–75 ng/mL may contribute). Medications such as gabapentin or low-dose dopamine agonists can be effective.
- For dream enactment (REM sleep behavior disorder), medical evaluation is important as it can be an early sign of neurodegenerative disease.
Common Sleep Disorders
Sleep disorders are common and often underdiagnosed. If you scored high in Domain 5 or have persistent sleep difficulties despite good sleep hygiene, one of these conditions may be contributing:
Insomnia Disorder:
- The most common sleep disorder, affecting 10–15% of adults chronically. Characterized by difficulty initiating sleep, maintaining sleep, or waking too early, accompanied by daytime impairment.
- Often perpetuated by maladaptive behaviors (excessive time in bed, napping, clock-watching) and cognitive factors (worry about sleep, catastrophizing about consequences).
- Treatment: Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard first-line treatment, recommended by all major sleep medicine organizations. It is more effective than medication long-term.
Obstructive Sleep Apnea (OSA):
- Affects an estimated 15–30% of men and 10–15% of women. The upper airway repeatedly collapses during sleep, causing breathing pauses (apneas) and oxygen desaturation.
- Key symptoms: loud snoring, witnessed breathing pauses, gasping or choking during sleep, morning headaches, excessive daytime sleepiness, and unrefreshing sleep.
- Treatment: Continuous Positive Airway Pressure (CPAP) is the gold standard. Oral appliances, positional therapy, weight loss, and surgery are alternatives depending on severity.
Restless Legs Syndrome (RLS) / Willis-Ekbom Disease:
- Affects 5–10% of adults. Characterized by an irresistible urge to move the legs, usually accompanied by uncomfortable sensations (crawling, tingling, aching). Symptoms worsen at rest and in the evening.
- Can significantly delay sleep onset and cause frequent nighttime awakenings.
- Treatment: Iron supplementation if ferritin is low, gabapentin or pregabalin, low-dose dopamine agonists, and lifestyle modifications (regular exercise, reducing caffeine and alcohol).
Narcolepsy:
- A neurological disorder affecting the brain’s ability to regulate sleep-wake cycles. Characterized by excessive daytime sleepiness, sleep attacks, and in Type 1, cataplexy (sudden muscle weakness triggered by emotions).
- Affects approximately 1 in 2,000 people. Often diagnosed years after symptom onset.
- Treatment: Stimulant medications for daytime sleepiness, sodium oxybate for nighttime sleep consolidation, and lifestyle management (scheduled naps, regular sleep schedule).
When to See a Sleep Specialist:
- You have been told you snore loudly or stop breathing during sleep
- You experience excessive daytime sleepiness despite adequate sleep time
- You have persistent difficulty falling or staying asleep that does not respond to good sleep hygiene
- You have uncomfortable leg sensations that prevent you from falling asleep
- You act out dreams or exhibit unusual behaviors during sleep
- You experience sudden muscle weakness during emotional situations
- Your sleep problems significantly impair your daytime functioning, mood, or quality of life
Frequently Asked Questions
The Comprehensive Sleep Quality Score evaluates your sleep across five distinct domains: Sleep Duration and Timing, Sleep Quality and Continuity, Daytime Impact, Sleep Environment and Habits, and Sleep Disorders Risk. Unlike single-dimension sleep questionnaires, this 18-question assessment provides a multi-factor view of your sleep health, identifying specific areas of strength and weakness. Your total score ranges from 0 to 54, where lower scores indicate better sleep quality. Each domain score helps pinpoint exactly where your sleep could improve.
The Pittsburgh Sleep Quality Index (PSQI) is a validated clinical instrument that assesses seven components of sleep quality over the past month, producing a global score from 0 to 21. This Comprehensive Sleep Quality Score is an educational self-assessment tool that covers similar territory but includes additional domains such as explicit sleep disorder risk screening and detailed sleep environment evaluation. The PSQI is a standardized clinical tool used in research and diagnosis; this assessment is designed for personal insight and education. If you need a clinically validated measure, we recommend the PSQI or consultation with a sleep specialist.
Scores of 0–12 indicate Excellent Sleep quality, meaning your sleep habits, environment, and outcomes are well-optimized across all five domains. Scores of 13–22 indicate Good Sleep, where minor improvements may be beneficial. Scores of 23–34 indicate Fair Sleep, suggesting several areas that could benefit from attention. Scores of 35–44 indicate Poor Sleep, where meaningful changes to sleep habits are strongly recommended. Scores of 45–54 indicate Very Poor Sleep, and professional consultation with a sleep specialist is advised.
The fastest improvements typically come from three changes: First, set a consistent wake time every day, including weekends, as this is the strongest anchor for your circadian rhythm. Second, create a screen-free wind-down period of at least 30 minutes before bed, replacing screens with reading, relaxation exercises, or light stretching. Third, optimize your sleep environment by making your bedroom dark, cool (65–68 degrees Fahrenheit), and quiet. Most people notice improvement within 1–2 weeks of consistently applying these changes. For more significant issues, review your domain scores and focus on the areas with the highest scores first.
Consider seeing a sleep specialist if: your Domain 5 (Sleep Disorders Risk) score is 5 or higher, indicating potential symptoms of sleep apnea, restless legs syndrome, or parasomnia; your total score is in the Poor or Very Poor range despite implementing good sleep hygiene for 2–4 weeks; you experience excessive daytime sleepiness that affects your safety or functioning; you have been told you snore loudly or stop breathing during sleep; or your sleep problems are significantly impacting your mood, relationships, or work performance. A sleep specialist can perform a thorough evaluation and, if needed, order a sleep study to diagnose underlying conditions.
This assessment evaluates your sleep over the past month, so retaking it every 4–6 weeks is ideal for tracking changes. This gives you enough time to implement improvements and see their effects. If you are making specific changes to your sleep habits, retaking the assessment after 4 weeks can help you measure progress. Use the history feature to compare your scores over time and identify trends. Avoid retaking it more frequently than every 2 weeks, as short-term variations may not reflect meaningful changes in your overall sleep quality.
Medical Disclaimer
This Comprehensive Sleep Quality Score is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. This is a self-assessment tool, not a clinically validated diagnostic instrument. Your results should be interpreted as general guidance and discussed with a qualified healthcare professional if you have concerns about your sleep. If you are experiencing symptoms of a sleep disorder (loud snoring, breathing pauses, excessive daytime sleepiness, restless legs), please consult a sleep medicine specialist. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.
References
- Walker M. Why We Sleep: Unlocking the Power of Sleep and Dreams. New York: Scribner; 2017.
- Buysse DJ. Sleep health: can we define it? Does it matter? Sleep. 2014;37(1):9-17.
- Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23-36.
- Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43.
Comprehensive Sleep Quality Score: An original multi-factor sleep assessment tool for educational purposes. Informed by sleep science research from Walker (2017), Buysse (2014), Irish et al. (2015), and Hirshkowitz et al. (2015).