Insomnia Screening English Test (ISI) Instruction For each question below, please circle the number corresponding most accurately to your sleep patterns in the LAST 2 WEEKS. 1. Difficulty falling asleep:*NoneMildModerateSevereVery Severe2. Difficulty staying asleep*NoneMildModerateSevereVery Severe3. Problem waking up too early in the morning:*NoneMildModerateSevereVery Severe4. How SATISFIED/dissatisfied are you with your current sleep pattern?*Very DissatisfiedDissatisfiedNeutralSatisfiedVery Satisfied5. To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, ability to function at work/daily chores, concentration, memory, mood)?*Not at all InterferingA little InterferingSomewhat InterferingVery InterferingExtremely Interfering6. How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?*Not at all NoticeableA little NoticeableSomewhat NoticeableVery NoticeableExtremely Noticeable7. How WORRIED/distressed are you about your current sleep problem?*Not at allA littleSomewhatVeryExtremely
