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Sleep problems checklist

Poor sleep is common with stress, anxiety, depression, pain and substance use — and it can also be a problem on its own (insomnia). This checklist helps you see how much sleep is affecting you.

Screening results do not establish a diagnosis. A qualified healthcare professional must perform a clinical assessment.

Sleep problems checklist

During the past month…

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This is Neuro Mind Bloom's own symptom checklist based on standard diagnostic features. It is not a published rating scale and cannot diagnose — it only helps you decide whether to consult.

  1. 1. Has it taken you more than 30 minutes to fall asleep?
  2. 2. Have you woken up during the night and found it hard to sleep again?
  3. 3. Have you woken up too early and could not go back to sleep?
  4. 4. Have you felt unrefreshed, sleepy or low in energy during the day?
  5. 5. Has poor sleep affected your mood, concentration, studies or work?
  6. 6. Have you worried a lot about not sleeping?
  7. 7. Have you needed sleeping pills, alcohol or other substances to sleep?
  8. 8. Has anyone noticed loud snoring with pauses in breathing, or have you woken up gasping?

Your answers are scored on this device only. Nothing is stored or sent to anyone.

About this questionnaire

Original checklist written by Neuro Mind Bloom. The Insomnia Severity Index (ISI) is licensed through Mapi Research Trust and is not reproduced here.