*Responses on this questionnaire will be analysed as part of a separate research project.* This questionnaire assesses seven different components of sleep: (1) Subjective sleep quality, (2) sleep latency, (3) sleep duration, (4) habitual sleep efficiency, (5) sleep disturbances, (6) use of sleeping medication, and (7) daytime dysfunction over the last month. Questionnaire items will be presented in a fixed order. -------- ### Sleep Quality Assessment 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. Please answer all questions. During the past month, 1. When have you usually gone to bed? ______ 2. How long (in minutes) has it taken you to fall asleep each night? ______ 3. What time have you usually gotten up in the morning? ______ 4. How many hours of actual sleep did you get at night? ______ How many hours were you in bed? ______ 5. During the past month, how often have you had trouble sleeping because you: [*Rating scale*: 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] - A. Cannot get to sleep within 30 minutes - B. Wake up in the middle of the night or early morning - C. Have to get up to use the bathroom - D. Cannot breathe comfortably - E. Cough or snore loudly - F. Feel too cold - G. Feel too hot - H. Have bad dreams - I. Have pain - J. Other reason(s), please describe, including how often you have had trouble sleeping because of this reason(s): ______ 6. During the past month, how often have you taken medicine (prescribed or "over the counter") to help you sleep? [*Rating scale*: 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] 7. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? [*Rating scale*: 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] 8. During the past month, how much of a problem has it been for you to keep enthusiasm to get things done? [*Rating scale*: 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] 9. During the past month, how would you rate your sleep quality overall? [*Rating scale*: 0 = Very good, 1 = Fairly good, 2 = Fairly bad, 3 = Very bad] ______ Scoring of components: 1. #9 score 2. #2 score (<15 min = 0, 16-30 min = 1, 31-60 min = 2, >60 min = 3) + #5a score. If sum is equal 0 = 0, 1-2 = 1, 3-4 = 2; 5-6 = 3 3. #4 score (>7 = 0, 6-7 = 1, 5-6 = 2, <5 = 3) 4. (total number of hours asleep)/(total number of hours in bed) x 100 5. sum of scores #5b to 5j (0 = 0, 1-9 = 1, 10-18 = 2, 19-27 = 3) 6. #6 score 7. #7 score + #8 score (0 = 0, 1-2 = 1, 3-4 = 2, 5-6 = 3) All seven components will then be added together to give the global PSQI score. A score of 5 or more is indicative of poor sleep quality. ------ ### References Buysse, D.J., Reynolds, C.F., Monk, T.H., Berman, S.R., & Kupfer,D.J. (1989). The Pittsburgh Sleep Quality Index (PSQI): A new instrument for psychiatric research and practice. *Psychiatry Research, 28*(2), 193-213.