PROMIS Sleep Disturbance Scale
Instructions: Please respond to each item by marking one box per item.
In the past 7 days. . .
Not
at all
A
Somewhat
little bit
Quite
a bit
Very
much
1.
My sleep was restless. . . . . . . . . . . . . . ( )
( )
( )
( )
( )
2.
I was satisfied with my sleep . . . . . . . . ( )
( )
( )
( )
( )
3.
My sleep was refreshing . . . . . . . . . . . ( )
( )
( )
( )
( )
4. I had difficulty falling asleep. . . . . . . . ( )
( )
( )
( )
( )
In the past 7 days. . .
Never
5.
Rarely
Sometimes Often Always
I had trouble staying asleep. . . . . . . . . ( )
( )
( )
( )
( )
6. I had trouble sleeping . . . . . . . . . . . . . ( )
( )
( )
( )
( )
7. I got enough sleep . . . . . . . . . . . . . . . ( )
( )
( )
( )
( )
Poor
Fair
Good
( )
( )
( )
In the past 7 days. . .
Very
poor
8.
My sleep quality was. . . . . . . . . . . . . . ( )
Very
good
( )
Note. Copyright 2008 by PROMIS Health Organization or other individuals/entities that
have contributed information and materials to Assessment Center. Reprinted with permission of the PROMIS Health Organization and the PROMIS Cooperative Group.
Mark P. Jensen
Hypnosis for Chronic Pain Management: Self-Report Measures Assessing Pain, Pain-Related Beliefs and Coping, and
Clinical Success. Copyright © 2011 by Oxford University Press
Oxford Clinical Psychology | Oxford University Press