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Insomnia Severity Index Fillable Form - Veterans Affairs

Insomnia Severity Index Fillable Form - Veterans Affairs 2025

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The document is a form for the Insomnia Severity Index, which assesses the severity of insomnia symptoms over the past two weeks. It includes questions regarding difficulty falling asleep, staying asleep, waking up too early, satisfaction with sleep patterns, interference with daily functioning, noticeability to others, and distress about sleep problems. The total score ranges from 0 to 28, categorizing insomnia severity from no clinically significant insomnia to severe clinical insomnia.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name and the date at the top of the form. This personal information is essential for tracking your responses.
For each question, select a box that best represents your experience over the last two weeks. Start with Question 1, rating the severity of your insomnia problems from 'None' to 'Very Severe'.
Proceed to Question 2, where you will assess your satisfaction with your current sleep pattern. Again, choose a response that reflects your feelings accurately.
In Question 3, evaluate how much your sleep problem interferes with daily functioning. Select from 'Not at all' to 'Very Much Interfering'.
Question 4 asks about how noticeable your sleep issues are to others. Choose an option that aligns with your perception.
Finally, in Question 5, indicate how worried or distressed you feel about your sleep problems. Make sure to select the most appropriate response.
Once completed, review all selections for accuracy before submitting or saving the form.

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What is the VA rating for severe insomnia?

The VA rates insomnia and most other sleep disorders using the General Rating Formula for Mental Disorders. The VA may grant you a rating of 0%, 10%, 30%, 50%, 70%, or 100% for insomnia, based on how severe symptoms are, how frequently they occur, and how much the condition interferes with your life.

Is the insomnia severity index free to use?

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How reliable is the insomnia severity index?

Yes, face and content validity; correlated with sleep diaries, polysomnography, and interviews; cutoff score of 10 had a 86.1% sensitivity and 87.7% specificity for detecting insomnia cases in the community sample.

What is the index of insomnia?

The Insomnia Severity Index (ISI) is composed of seven items that evaluate the severity of sleep disturbance during the past 2 weeks. Each item is rated on a five-point Likert scale and the total score indicates the severity of insomnia.

What is the insomnia severity index?

The insomnia severity index (Morin, 1993) is a short seven-item questionnaire that attempts to define the severity of both the nighttime and daytime impacts of insomnia over the past month (Morin, 1993).

What is the cut off for insomnia severity scale?

Insomnia Severity Index (ISI) The total score is interpreted as follows: absence of insomnia (07); sub-threshold insomnia (814); moderate insomnia (1521); and severe insomnia (2228). Three versions are availablepatient, clinician, and docHub othersbut the present paper focuses on the patient version only.

How to measure severity of insomnia?

The Insomnia Severity Index (ISI) is a seven-item self-report questionnaire used to assess the severity of the insomnia disorder (score 8-14 is mild and 15 or more moderate to severe insomnia), impact on daily life and treatment response.

Insomnia Severity Index Fillable Form - Veterans Affairs 2025

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