The Pittsburgh Sleep Quality Index (PSQI)

Best Practices in Nursing Care to Older Adults from The Hartford Institute for Geriatric Nursing, New York University, College of Nursing

Issue Number 6.1, Revised 2007
Series Editor: Marie Boltz, MSN, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing
__________________________________________________________________________________________________________________________

WHY: For all people, sleep is part of the rhythm of life. Without a “good” sleep, the body loses the ability to revitalize, the mind is less adept and one’s mood is altered. Circadian rhythms have a major impact on older adults’ health and well-being. Normal aging changes conspire to interfere with the quality of sleep, while health and medication use can affect the sleep patterns in a negative manner. A nursing assessment of sleep begins with a comprehensive assessment of sleep quality and sleep patterns. The nurse may be able to improve the sleep problem immediately with interventions or work with the health care team to assess the sleep problem in greater depth.

BEST TOOL: The Pittsburgh Sleep Quality Index (PSQI) is an effective instrument used to measure the quality and patterns of sleep in the older adult. It differentiates “poor” from “good” sleep by measuring seven areas: subjective sleep quality, sleep latency, sleep duration, habitual sleep ef.ciency, 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 re.ects 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 re.ected in the attached instrument; refer to “More on the Topic”, Buysse, et al., 1989, for these questions).

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

VALIDITY AND RELIABILITY: The PSQI has internal consistency and a reliability coef.cient (Cronbach’s alpha) of 0.83 for its seven components. Numerous studies using the PSQI in a variety of older adult populations throughout the world have supported high validity and reliability.

STRENGTHS AND LIMITATIONS: The PSQI is a subjective measure of sleep. Self-reporting can empower the client, but can re.ect inaccurate information if the client has dif.culty understanding what is written, or cannot see or physically write out responses. Moreover, the scale is presented in English and has been used mostly in English speaking countries, with recent studies validating Chinese and Japanese versions. The scale can be adapted to enable the client to respond verbally to items on the scale by having the nurse read the statements to the client.

MORE ON THE TOPIC:
Best practice information on care of older adults: www.GeroNurseOnline.org.

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. Journal of Psychiatric Research, 28(2), 193-213.

Cole, J.C., Motivala, S.J., Buysse, D.J., Oxman, M.N., Levin, M.J., & Irwin, M.R. (2006). Validation of a 3-factor scoring model for the Pittsburgh Sleep Quality Index in older adults. Sleep, 29(1), 112-116.

Lai, H.L. (2005). Self-reported napping and nocturnal sleep in Taiwanese elderly insomniacs. Public Health Nursing, 22(3), 240-247.

Motivala, S.J., Levin, M.J., Oxman, M.N., & Irwin, M.R. (2006). Impairments in health functioning & sleep quality in older adults with a history of depression. JAGS, 54(8), 1184-1191.

Tsai, P.S., Wang, S.Y., Wang, M.Y., Su, C.T., Yang, T.T., Huang, C.J., & Fang, S.C. (2005). Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects. Quality of Life Research, 14(8), 1943-1952.

The Pittsburgh Sleep Quality Index (PSQI)

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 do you get at night? (This may be different than the number of hours you spend in bed)

5. During the past month, how often have you had trouble sleeping because you…

Not during the past month (0)
Less than once a week (1)
Once or twice a week (2)
Three or more times a week (3)

a. Cannot get to sleep within 30 minutes -  (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
b. Wake up in the middle of the night or early morning - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
c. Have to get up to use the bathroom - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
d. Cannot breathe comfortably - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
e. Cough or snore loudly - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
f. Feel too cold - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
g. Feel too hot - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
h. Have bad dreams - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
i. Have pain - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)
j. Other reason(s), please describe, including how often you have had trouble sleeping because of this reason(s): (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)

6. During the past month, how often have you taken medicine (prescribed or “over the counter”) to help you sleep? - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)

7. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)

8. During the past month, how much of a problem has it been for you to keep up enthusiasm to get things done? - (0) Less than once a week (1) Once or twice a week (2) Three or more times a week (3)

9. During the past month, how would you rate your sleep quality overall? - Very good (0) Fairly good (1) Fairly bad (2) Very bad (3)

Component 1 #9 Score C1_____
Component 2 #2 Score (≤15min=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) 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 _____

Reprinted from Journal of Psychiatric Research, 28(2), Buysse, D.J., Reynolds III, C.F., Monk, T.H., Berman, S.R., & Kupfer, D.J. The Pittsburgh Sleep Quality Index: A New Instrument for Psychiatric Practice and Research, 193-213, Copyright 1989, with permission from Elsevier Science. Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that The Hartford Institute for Geriatric Nursing, College of Nursing, New York University is cited as the source. This material may be downloaded and/or distributed in electronic format, including PDA format. Available on the internet at www.hartfordign.org and/or www.GeroNurseOnline.org. E-mail notification of usage to: hartford.ign@nyu.edu. A SERIES PROVIDED BY The Hartford Institute for Geriatric Nursing EMAIL: hartford.ign@nyu.edu HARTFORD INSTITUTE WEBSITE: www.hartfordign.org GERONURSEONLINE WEBSITE: www.GeroNurseOnline.org