Pittsburgh Sleep Quality Index (PSQI)

Comprehensive 7-Component Sleep Assessment — Gold Standard

★ Gold Standard ⚗ 7 Components 🔒 100% Private
9 Questions 7 Components
Score 0–21 Range
>5 = Poor Sleep Quality
🔒 Your Privacy: All responses are processed entirely in your browser. No data is stored on our servers or shared with anyone. Your answers remain completely private.

PSQI Questionnaire

The following questions relate to your usual sleep habits during the past month only. Your answers should indicate the most accurate reply for the majority of days and nights in the past month.

Sleep Timing & Duration

Enter your typical bedtime, wake time, and sleep details from the past month.

1. During the past month, what time have you usually gone to bed at night?

Select your usual bedtime (e.g., 11:00 PM)

2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night?

Enter the number of minutes it typically takes to fall asleep

3. During the past month, what time have you usually gotten up in the morning?

Select your usual wake time (e.g., 7:00 AM)

4. During the past month, how many hours of actual sleep did you get at night? (This may be different from the number of hours you spent in bed.)

Enter hours of actual sleep (use decimals, e.g., 6.5 for 6 hours 30 min)

Sleep Disturbances

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

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. Had bad dreams

5i. Have pain

Sleep Medication & Daytime Function

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

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 enough enthusiasm to get things done?

Overall Sleep Quality

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

Understanding the PSQI

The Pittsburgh Sleep Quality Index (PSQI) was developed by Dr. Daniel J. Buysse and colleagues at the University of Pittsburgh in 1989. It has become the most widely used standardized self-report measure of sleep quality in both clinical and research settings, cited in over 10,000 published studies.

What each component measures:

  • C1 — Subjective Sleep Quality: Your own perception of how well you sleep. This single-item component reflects your global assessment of sleep quality, which research shows is a reliable indicator of overall sleep health.
  • C2 — Sleep Latency: How long it takes you to fall asleep. Prolonged sleep latency (more than 30 minutes) is associated with hyperarousal, anxiety, and conditioned insomnia.
  • C3 — Sleep Duration: The total hours of actual sleep per night. Adults generally need 7–9 hours, and consistently sleeping less than 6 hours is associated with increased mortality and morbidity.
  • C4 — Habitual Sleep Efficiency: The percentage of time in bed actually spent sleeping. An efficiency below 85% may indicate a mismatch between time in bed and sleep ability.
  • C5 — Sleep Disturbances: The frequency and variety of nighttime disruptions, from waking up at night to pain, breathing problems, and temperature discomfort.
  • C6 — Use of Sleep Medication: How often you rely on sleep aids, whether prescription or over-the-counter. Regular use may indicate untreated sleep disorders.
  • C7 — Daytime Dysfunction: How much your sleep problems affect your daily functioning, including drowsiness and difficulty maintaining enthusiasm.

Why 7 components? The PSQI was specifically designed to capture the multidimensional nature of sleep quality. A person might sleep for 8 hours but experience frequent awakenings (low efficiency), or sleep deeply but for too few hours (short duration). By measuring seven distinct aspects, the PSQI provides a comprehensive picture that a single question about sleep quality cannot.

Clinical use: The PSQI is used in primary care, sleep medicine, psychiatry, oncology, cardiology, and many other fields. It helps clinicians identify which specific aspects of sleep are problematic, guide treatment decisions, and monitor treatment response over time. A global score above 5 correctly identifies poor sleepers with a diagnostic sensitivity of 89.6% and specificity of 86.5%.

Sleep Quality Factors

Understanding each sleep quality dimension helps you identify where improvements can be made:

Sleep Duration:

  • The National Sleep Foundation recommends 7–9 hours for adults (ages 18–64) and 7–8 hours for older adults (65+)
  • Both short sleep (<6 hours) and long sleep (>9 hours) are associated with increased health risks including cardiovascular disease, diabetes, obesity, and depression
  • Individual sleep needs vary due to genetics; some people genuinely function well on 6 hours while others need 9
  • Sleep need does not decrease significantly with age, though the ability to maintain sleep often does

Sleep Efficiency:

  • Sleep efficiency is calculated as: (hours of actual sleep / hours spent in bed) × 100%
  • Healthy sleep efficiency is typically above 85%. Values below 75% suggest significant sleep maintenance problems
  • Spending excessive time in bed awake trains the brain to associate the bed with wakefulness, creating a vicious cycle
  • Stimulus control therapy (only being in bed when sleepy) is one of the most effective behavioral interventions for improving sleep efficiency

Sleep Latency:

  • Normal sleep onset latency is typically 10–20 minutes
  • Falling asleep in less than 5 minutes may indicate sleep deprivation or a sleep disorder like narcolepsy
  • Taking more than 30 minutes regularly suggests onset insomnia, which can be caused by hyperarousal, anxiety, irregular schedules, or poor sleep hygiene
  • Cognitive behavioral techniques like paradoxical intention and cognitive restructuring are highly effective for reducing sleep latency

Sleep Disturbances:

  • Frequent nighttime awakenings, nocturia (bathroom trips), breathing difficulties, snoring, pain, temperature discomfort, and nightmares all fragment sleep
  • Sleep fragmentation impairs the restorative functions of sleep even when total sleep time is adequate
  • Many disturbances have treatable underlying causes (e.g., sleep apnea, restless legs syndrome, nocturia, chronic pain)

Evidence-Based Strategies for Improving Sleep

Research supports the following approaches for improving sleep quality:

Cognitive Behavioral Therapy for Insomnia (CBT-I):

  • CBT-I is the first-line treatment for chronic insomnia, recommended by the American College of Physicians over medication
  • It is as effective as sleeping pills in the short term and more effective in the long term, with benefits that persist after treatment ends
  • Components include sleep restriction, stimulus control, cognitive restructuring, relaxation training, and sleep hygiene education
  • Available through therapists, online programs (e.g., Insomnia Coach, SHUTi), and apps

Sleep Hygiene:

  • Consistent schedule: Go to bed and wake up at the same time every day, including weekends. This strengthens your circadian rhythm.
  • Light exposure: Get bright light (ideally sunlight) within 30 minutes of waking. Dim lights 2 hours before bedtime. These light cues are the strongest signal for your body clock.
  • Temperature: Keep your bedroom cool (60–67°F / 15–19°C). Core body temperature naturally drops during sleep; a cool environment facilitates this.
  • Screen time: Avoid screens for at least 30–60 minutes before bed. Blue light suppresses melatonin production. If you must use screens, use night mode or blue-light blocking glasses.
  • Caffeine: Avoid caffeine after 2:00 PM (or at least 8 hours before bedtime). Caffeine has a half-life of 5–7 hours and blocks adenosine, the chemical that builds sleep pressure.
  • Alcohol: While alcohol may help you fall asleep faster, it disrupts sleep architecture, reduces REM sleep, and increases nighttime awakenings. Avoid alcohol within 3–4 hours of bedtime.
  • Exercise: Regular moderate exercise improves sleep quality, but avoid vigorous exercise within 2–3 hours of bedtime as it can increase alertness.

Environment Optimization:

  • Use blackout curtains or an eye mask to eliminate light
  • Use earplugs or a white noise machine to mask disruptive sounds
  • Reserve the bed for sleep and intimacy only — avoid working, watching TV, or scrolling in bed
  • Invest in a comfortable mattress and pillow appropriate for your sleep position

When to See a Doctor

While poor sleep is common, certain patterns may indicate a sleep disorder that requires medical evaluation:

Sleep Apnea:

  • Loud, chronic snoring (especially with witnessed pauses in breathing)
  • Gasping or choking during sleep
  • Excessive daytime sleepiness despite apparently adequate sleep time
  • Morning headaches and dry mouth
  • Affects approximately 22 million Americans; up to 80% of moderate-to-severe cases remain undiagnosed
  • Untreated sleep apnea significantly increases the risk of hypertension, heart disease, stroke, and type 2 diabetes

Restless Legs Syndrome (RLS):

  • An irresistible urge to move the legs, typically accompanied by uncomfortable sensations
  • Symptoms worsen during rest and in the evening/night
  • Movement provides temporary relief
  • Can cause significant difficulty falling asleep and maintaining sleep
  • May be related to iron deficiency, kidney disease, or peripheral neuropathy

Narcolepsy:

  • Overwhelming daytime drowsiness despite adequate nighttime sleep
  • Sudden muscle weakness triggered by emotions (cataplexy)
  • Sleep paralysis and vivid hallucinations when falling asleep or waking up
  • Often undiagnosed for years; average time to diagnosis is 7–10 years after symptom onset

Referral criteria — see a healthcare provider if you experience:

  • Persistent insomnia lasting more than 3 months despite good sleep hygiene
  • Daytime sleepiness that impairs your ability to drive, work, or function safely
  • PSQI global score consistently above 5, especially above 10
  • Snoring combined with observed breathing pauses or excessive daytime sleepiness
  • Unusual behaviors during sleep (sleepwalking, acting out dreams, violent movements)
  • Persistent leg discomfort or jerking that disrupts sleep

Frequently Asked Questions

The Pittsburgh Sleep Quality Index (PSQI) is a self-report questionnaire developed by Dr. Daniel J. Buysse and colleagues at the University of Pittsburgh in 1989. It assesses sleep quality and disturbances over a one-month period. The PSQI generates seven component scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction) and one global score ranging from 0 to 21. It is the most widely used and validated measure of sleep quality in clinical practice and research, having been translated into over 50 languages and used in thousands of published studies.

A global PSQI score greater than 5 indicates “poor sleep quality.” This cutoff was established in the original validation study by Buysse et al. (1989) and has been consistently supported in subsequent research. At this threshold, the PSQI correctly identifies poor sleepers with a sensitivity of 89.6% and a specificity of 86.5%. Scores of 6–10 typically indicate moderate sleep difficulty, while scores above 10 suggest severe sleep problems that may significantly impact health and daily functioning. However, the global score should be considered alongside the individual component scores to understand which specific aspects of sleep are most affected.

Sleep efficiency is calculated as: (hours of actual sleep / total hours spent in bed) × 100%. For example, if you go to bed at 11:00 PM and get up at 7:00 AM (8 hours in bed) but only actually sleep 6 hours, your sleep efficiency is (6 / 8) × 100% = 75%. The PSQI scores sleep efficiency as: greater than 85% = 0 (good), 75–84% = 1 (fair), 65–74% = 2 (poor), and less than 65% = 3 (very poor). Healthy sleepers typically have an efficiency above 85%. Low efficiency often results from prolonged time awake in bed, which can perpetuate insomnia through conditioned arousal.

Poor sleep quality can result from many factors, often acting in combination: (1) Behavioral factors — irregular sleep schedules, excessive screen time before bed, caffeine or alcohol use, and spending too much time in bed awake; (2) Medical conditions — sleep apnea, restless legs syndrome, chronic pain, GERD, thyroid disorders, and neurological conditions; (3) Mental health — anxiety, depression, PTSD, and stress are strongly associated with sleep disturbance; (4) Environmental factors — noise, light, temperature extremes, and an uncomfortable sleep surface; (5) Medications — many common medications (beta-blockers, SSRIs, corticosteroids, stimulants) can disrupt sleep; and (6) Age-related changes — sleep architecture changes naturally with aging, with more nighttime awakenings and lighter sleep.

The PSQI asks about sleep quality over the past month, so it should be administered no more frequently than once per month. In clinical settings, it is commonly used at baseline and then at monthly intervals to track treatment response. For self-monitoring, taking it once a month provides a good picture of your sleep quality trajectory over time. If you are undergoing treatment for a sleep disorder, your healthcare provider may recommend specific reassessment intervals. Keep in mind that single assessments provide only a snapshot — tracking your PSQI score over several months gives a more reliable picture of your sleep health.

No. The PSQI is a screening and measurement tool, not a diagnostic instrument. It measures the severity and pattern of sleep quality problems, but it cannot diagnose specific sleep disorders such as insomnia disorder, obstructive sleep apnea, narcolepsy, restless legs syndrome, or any other clinical condition. A diagnosis of a sleep disorder requires a comprehensive evaluation by a qualified healthcare professional, which may include a detailed clinical interview, sleep diary review, actigraphy, and in some cases a polysomnography (overnight sleep study). The PSQI is best used as a starting point for conversations with your healthcare provider about your sleep concerns.

Medical Disclaimer

This PSQI Assessment is provided for educational and informational purposes only and does not constitute medical advice, diagnosis, or treatment. The PSQI is a screening tool, not a clinical diagnostic instrument. Your results should be interpreted in the context of a comprehensive assessment by a qualified healthcare professional. If you are experiencing persistent sleep problems that affect your daily functioning, safety (e.g., drowsy driving), or health, please consult a healthcare provider or sleep specialist. All calculations are performed in your browser — no personal data is stored on our servers or shared with any third party.

Related Assessments

ISI Insomnia

Assess insomnia severity with the validated 7-item Insomnia Severity Index.

Sleep Calculator

Calculate optimal bedtime and wake time based on sleep cycles.

Sleep Debt Calculator

Track and calculate your accumulated sleep debt over time.

DASS-21

Assess depression, anxiety, and stress with the validated 21-item DASS scale.

Stress Level

Evaluate your current stress level and get personalized coping strategies.

References

  1. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213.
  2. Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A. The Pittsburgh Sleep Quality Index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016;25:52-73.
  3. Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res. 2002;53(3):737-740.
  4. Carpenter JS, Andrykowski MA. Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res. 1998;45(1):5-13.

PSQI: Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.