The Pittsburgh Sleep Quality Index

MedSurg Nursing, August, 2003 by Carole Smyth

WHY: Sleep is a necessary part of life. However, normal aging changes, medical problems, psychiatric problems, and psychosocial issues can alter the pattern and quality of sleep as one grows older, and thus affect the quality of life in older adults. Assessment of sleep patterns enables the nurse to intervene immediately by implementing interventions with the client, or referring the client for further assessment.

BEST TOOL: The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument used to measure the quality and patterns of sleep in older adults. It differentiates "poor" from "good" sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction over the last month. The client self-rates each of these seven areas of sleep. Scoring of answers is based on a 0 to 3 scale, whereby 3 reflects the negative extreme on the Likert Scale. A global sum of "5" or greater indicates a "poor" sleeper. Although there are several questions that request the evaluation of the client's bedmate or roommate, these are not scored (not reflected in attached instrument). Refer to "More on the Topic," Buysse et al., 1989, for these questions.

TARGET POPULATION: The PSQI can be used for both initial assessment and ongoing comparative measurements with older adults across all health care settings.

VALIDITY/RELIABILITY: The PSQI has internal consistency and a reliability coefficient (Cronbach's alpha) of 0.83 for its seven components. Numerous studies using the PSQI have supported high validity and reliability.

STRENGTHS AND LIMITATIONS: The PSQI is a subjective measure of sleep. Self-reporting by clients can empower the client, but can reflect inaccurate information if the client has difficulty understanding what is written, or can not see or physically write out responses. Moreover, the scale is presented in English. The scale can be adapted to enable clients to respond verbally to items on the scale by having the nurse read the statements to the client.

MORE ON THE TOPIC: Beaton, S.R., & Voge, S.A. (1998). Measurement of long-term care (pp. 169-170). Thousand Oaks, CA: Sage Publications. Beck-Little, R., & Weinrich, S.P. (1998). Assessment and management of sleep disorders in the elderly. Journal of Gerontological Nursing, 24 (4), 21-29.

Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatric Research, 28 (2), 193-213.

Pittsburgh Sleep Quality Index

Instructions: 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. When have you usually gotten up in the morning? --

4. How many hours of actual sleep did you get that night? (This may be different than the number of hours you spend in bed) --

5. During the past month,      Not         Less                 Three
   how often have you had     during       than     Once or    or more
   trouble sleeping          the past     once a    twice a    times a
   because you ...           month (0)   week (1)   week (2)   week (3)

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?

7. During the past month,
   how often have you had
   trouble staying awake
   while driving, eating
   meals, or engaging in
   social activity?

8. During the past month,
   how much of a problem
   has it been for you to
   keep up enthusiasm to
   get things done?

                               Very       Fairly    Fairly      Very
                             good (0)    good (1)   bad (2)    bad (3)

9. During the past month,
   how would you rate your
   sleep quality overall?

Component 1   #9 Score                                            C1 --

Component 2   #2 Score ([less than or equal to] 15min (0),
              16-30 min (1), 31-60 min (2), >60 rain (3)) + #5a
              Score (if sum is equal 0-0; 1-2=1; 3-4=2; 5-6=3)    C2 --

Component 3   #4 Score (>7(0), 6-7(1), 5-6(2), <5 (3)             C3 --

Component 4   (total # of hours asleep)/(total # of hours in
              bed) x 100 >85%=0, 75%-84%=1, 65%-74%=2, <65%=3     C4 --

Component 5   # sum of scores 5b to 5j (0=0; 1-9=1; 10-18=2;
              19-27=3)                                            C5 --

Component 6   #6 Score                                            C6 --

Component 7   #7 score + #8 score (0=0; 1-2=1; 3-4=2; 5-6=3)      C7 --

Add the seven component scores together --

Global PSQI Score --

Adapted from: Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman,
S.R., & Kupfer, D.J. (1989). The Pittsburgh Sleep Quality Index: a new
instrument for psychiatric practice and research. Psychiatric Research,
28(2), 193-213, with permission from Elsevier Science.

MEDSURG Nursing is pleased to publish this regular feature, "Try This: Best Practices in Nursing Care to Older Adults," developed by the Hartford Institute for Geriatric Nursing.

This article was reprinted with permission from "Try This: Best Practices in Nursing Care to Older Adults" series from the John A. Hartford Foundation Institute for Geriatric Nursing. Mathy Mezey, EdD, RN, FAAN, is Director of the Institute and Terry Fulmer, PhD, RN, FAAN is Co-Director. Series Editor is Sheila Molony, MS, RN,C.

Address correspondence to the John A. Hartford Foundation Institute for Geriatric Nursing, New York University, The Steinhardt School of Education, Division of Nursing, 246 Greene St, 5th Floor, New York, NY 10003, or call (212) 998-9018, or email hartford.ign@nyu.edu or access the Website at www.hartfordign.org.

Permission is hereby granted to reproduce this material provided The Hartford Institute for Geriatric Nursing, Division of Nursing, New York University is cited as the source. Available on the Internet at www.hartfordign.org. E-mail notification of usage would be appreciated to: hartford.ign@nyu.edu.