What Is the The Pittsburgh Sleep Quality Index (PSQI)?

The Pittsburgh Sleep Quality Index (PSQI) is a questionnaire that is used to evaluate sleep problems. If you have concerns about your sleep, your doctor may have you answer the questions as part of your medical workup.

The questionnaire includes an assessment of different aspects of your sleep, as well as some features of your daytime functioning. The result is used to get an idea about the quantity and quality of your sleep.

PSQI Is a Self-Administered Test
Getty Images/Luis Alvarez

What Is the PSQI?

The PSQI was developed in 1989 by researchers at the University of Pittsburgh. It is a self-administered questionnaire that includes 19 questions that you would answer about yourself and five additional optional questions that can be answered by someone who sleeps in the same room or bed with you.

The questions are all intended to be answered based on your sleeping pattern for the past month.

Questions involve:

  • The amount of time you spend asleep
  • How long it takes you to fall asleep
  • Factors that disturb your sleep (such as breathing issues, pain, or bad dreams)
  • Your use of sleeping medications
  • How well you function during the day

Your roommate’s questions are focused on things that you might not be aware of when you are sleeping—like whether you have excessive movements, confusion, and/or snoring. 

The PSQI takes about 10 minutes to complete and it doesn’t involve any procedures or interventions.

Purpose of Test

The purpose of this test is to evaluate your sleep habits, whether you have disturbed sleep, and your motivation and concentration when you are awake.

The questionnaire is used in the clinical evaluation of sleep disturbances and it is also used as a research tool, such as when medications or other factors that affect sleep are being examined in research studies. 

Your doctor might have you answer the questions on this test if you have complaints about your sleep or if you are complaining about excessive tiredness during the time that you would like to be awake. 

You might take the PSQI if you:

  • Can’t fall asleep 
  • Wake up during your sleep
  • Wake up before you want to 
  • Toss and turn when you are trying to sleep 
  • Feel like you aren’t getting enough sleep 
  • Feel sleepy during waking hours
  • Fall asleep when you should be awake 
  • Experience disruptive behaviors before, after, or during your sleep

The PSQI can be part of a comprehensive sleep evaluation. Your full sleep assessment might also include filling out a sleep diary and getting diagnostic studies such as a polysomnogram (overnight sleep study), brain imaging tests, or daytime multiple sleep latency test (MSLT).

You may also need a medical evaluation to evaluate health issues that could be contributing to your sleep problems. 

Risks and Contraindications

There are no risks to actually taking the test, but it should be used and interpreted under medical supervision. The PSQI is not intended for home use or to be used or interpreted on your own.

The results can provide you with the opportunity to consider and discuss aspects of your sleep that you might not have thought about before seeing the questions. But a sleep evaluation and treatment of sleep disorders requires consultation with a medical professional. 

Interpreting Results

The test is scored based on a scoring system that allots a certain number of points for each answer. Your doctor will discuss your score with you, along with your individual answers. The score and the answers are both important in guiding your next steps.

Your PSQI score provides insight into the severity and impact of your sleep problem, and your specific answers point to the cause.

After your test, you and your doctor can discuss the implications of your responses and make a plan for the next steps of your evaluation and treatment. 

The results of the PSQI do not independently provide a diagnosis of your sleep problem. But it does provide valuable insight and direction that your doctor may use in making a diagnosis. Your PSQI test results are interpreted in the context of your medical history, physical examination, and other diagnostic tests. 

Sleep disturbances and daytime fatigue can both be caused by a variety of medical issues, including insomnia, thyroid disease, sleep apnea, restless leg syndrome, psychiatric problems, pain, medication side effects, and more.

You may need additional diagnostic tests to help pinpoint your exact problem. For example, if you frequently wake up to use the toilet, you may need a blood test or a urine test to check for elevated sugar levels, which is a sign of diabetes.

In males, a prostate examination would also be warranted if they frequently awaken to urinate, because an enlarged prostate can cause this symptom.

Snoring may point to the need for further evaluation with a polysomnogram and overnight pulse oximeter, which can detect breathing problems. And issues related to confusion or altered behavior may point to dementia or another neurological condition—this concern would be evaluated with a thorough neurological examination, and possibly with imaging tests of the brain.

Follow-Up

Once you have a diagnosis, your doctor will work with you on a plan to help you get better sleep. Your treatment plan depends on your diagnosis. 

Treatment can include strategies such as:

  • Discontinuing medications that interfere with your sleep
  • Taking medication for diabetes
  • Getting treatment for prostate disease 
  • Getting treatment for pain or for a medical condition
  • Taking thyroid medication or adjusting your thyroid medication prescription 
  • Using a Bilevel Positive Airway Pressure (BiPAP) mask for treatment of sleep apnea
  • Going to counseling and therapy for anxiety or depression

These are just a few of the treatment strategies that can be used to treat problems that interfere with sleep. 

Sometimes the PSQI is administered again after treatment is started as a way to reevaluate whether your treatment is working. 

A Word From Verywell

The PSQI might be part of your sleep evaluation. It can be used as a tool to help you and your doctor identify problems in your sleep pattern, and it can also guide further diagnostic testing if necessary. Taking this self-administered test can also give you a good deal of insight into what you are going through.

You might not notice certain aspects of your sleep pattern, and this questionnaire also gives your roommate or sleeping partner a chance to contribute to your sleeping assessment. Most of the time, sleeping problems can be effectively treated so you can have more satisfying sleep and more energy and a better mood during the day.

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