Sleep questionnaire template: Free downloadable PDF

Key Takeaways

A sleep questionnaire is a validated, patient-reported screening tool that measures sleep quality, daytime sleepiness, insomnia severity, or sleep apnea risk in a standardized, scored format.

The four most widely used adult instruments are the Pittsburgh Sleep Quality Index (PSQI) for overall sleep quality, the Epworth Sleepiness Scale (ESS) for daytime sleepiness, the Insomnia Severity Index (ISI) for insomnia severity, and STOP-BANG for obstructive sleep apnea risk.

Each instrument has its own score range and cutoff: a PSQI score above 5, an ESS score of 11 or higher, an ISI score of 15 or higher, or a STOP-BANG score of 3 or higher all point to a problem that needs a closer look.

Practice management software like Pabau lets clinicians deliver these questionnaires through digital intake forms and store scores in the patient record, so results are ready before the visit and easy to track over time.

A sleep questionnaire is a validated screening tool that helps clinicians spot patients who report poor sleep quality, excessive daytime sleepiness, insomnia symptoms, or a high risk of obstructive sleep apnea. Download the free PDF template above, then use the sections below to pick the right instrument, score it, and fit it into your intake workflow.

What is a sleep questionnaire?

A sleep questionnaire is a standardized, patient-reported instrument that gathers objective, validated information about a patient’s sleep quality, daytime symptoms, and sleep-related risk factors. Unlike an informal question about how someone slept, each instrument follows a fixed set of items and a published scoring method, so results are comparable across patients and over time.

Sleep questionnaires split into two broad groups. Some measure sleep quality and insomnia symptoms over the past month, such as the Pittsburgh Sleep Quality Index (PSQI) and the Insomnia Severity Index (ISI). Others screen for a specific condition, such as excessive daytime sleepiness with the Epworth Sleepiness Scale (ESS) or obstructive sleep apnea risk with the STOP-BANG questionnaire.

Most take 5 to 10 minutes to complete and can be delivered on paper or digitally. They typically ask about sleep duration, perceived sleep quality, snoring or breathing symptoms, and daytime function, then produce a numerical score that maps to a published cutoff.

It is a screening and severity-assessment tool, not a diagnostic test. A high score is a reason to investigate further, not a diagnosis. Depending on the result, that might mean a closer clinical history, a referral to primary care or a sleep medicine specialist, or an overnight sleep study, also called polysomnography, billed under CPT 95810.

A positive screen does not, by itself, confirm primary insomnia, coded as F51.01, or obstructive sleep apnea, coded as G47.33.

Adult sleep questionnaires compared

Four validated instruments cover most adult sleep-screening needs in general and specialty practice. Each targets a different domain and takes only a few minutes to complete.

The PSQI is the most detailed of the four and produces seven component scores alongside its global score. If PSQI is your primary instrument, our PSQI template covers the full 19-item questionnaire and component-level scoring in more depth.

How to score and interpret sleep questionnaire results

Each instrument sums its own items into a total score, and each has its own published cutoff. Scoring one against another instrument’s thresholds isn’t valid, so keep the four ranges below separate.

Pittsburgh Sleep Quality Index (PSQI): Sum all 19 items into a global score from 0 to 21. A score above 5 indicates poor sleep quality, with a sensitivity of around 89.6% and a specificity of around 86.5% for identifying sleep disorders. See our PSQI template for the seven component scores behind that global number.

Epworth Sleepiness Scale (ESS): Patients rate how likely they are to doze off in eight everyday situations on a 0-3 scale, for a total from 0 to 24. Scores from 0 to 10 sit within the normal range; a score of 11 or higher indicates excessive daytime sleepiness and supports a closer look at conditions like sleep apnea or narcolepsy.

Insomnia Severity Index (ISI): Seven items are each scored 0 to 4, for a total from 0 to 28. A score of 0-7 shows no clinically significant insomnia, 8-14 is subthreshold insomnia, 15-21 is moderate insomnia, and 22-28 is severe insomnia. A score of 15 or higher is the threshold most often used to flag a patient for a clinical insomnia work-up.

STOP-BANG: Score one point for each “yes” answer across the eight items (snoring, tiredness, observed apnea, high blood pressure, BMI over 35, age over 50, neck circumference over 40 cm/16 in, and male gender), for a total from 0 to 8. A score of 0-2 is low risk, 3-4 is intermediate risk, and 5-8 is high risk for moderate-to-severe obstructive sleep apnea. At a cutoff of 3 or higher, STOP-BANG has a sensitivity of around 93% for moderate-to-severe OSA.

Across all four instruments, a positive screen is a reason to investigate further, not a diagnosis. Interpretation should always factor in the patient’s broader clinical picture rather than a single score in isolation.

How to use a sleep questionnaire in your practice workflow

Building a sleep questionnaire into routine intake catches sleep problems earlier and gives you an objective starting point for the conversation. Five steps cover most practice settings.

1. Pick the instrument that matches the complaint. Use the PSQI or ISI for general sleep-quality or insomnia complaints, the ESS when daytime sleepiness or fatigue is the presenting issue, and STOP-BANG when snoring, witnessed apnea, or obesity raise the possibility of sleep apnea.
2. Send it to the patient digitally. Digital intake forms let a patient complete the questionnaire on a tablet or phone before the appointment, so the score is ready when they’re seen.
3. Score it before or at the start of the visit. Each instrument has its own cutoff, so keep a quick-reference sheet on hand until scoring becomes second nature to your team.
4. Document the score in the patient’s record. Store the total score, the date, and the instrument used in the patient record so it is there for comparison at the next visit.
5. Refer based on the result. A high PSQI or ISI score usually points toward a sleep-medicine referral or CBT-I; a high STOP-BANG score points toward an OSA work-up and possibly a sleep study. Either way, the score gives you an objective starting point for that conversation with the patient.

Who is a sleep questionnaire helpful for?

A sleep questionnaire is useful anywhere a patient’s sleep, breathing, or daytime function is part of the clinical picture.

• Primary care and family practices use it as a quick screen at routine visits, especially when a patient mentions fatigue, snoring, or trouble sleeping, often alongside other brief instruments such as the AUDIT alcohol screening test, billable under G0442.
• Mental health and psychology practices build sleep screening into depression, anxiety, and PTSD evaluations, since poor sleep is a common symptom of all three.
• Sleep medicine specialists use it to triage referrals and decide who needs polysomnography or a CPAP trial.
• Occupational health and employee wellness programs use brief instruments like the ESS and STOP-BANG to flag fatigue-related and OSA-related safety risk in shift workers and safety-critical roles.

Benefits of using a sleep questionnaire template in your practice

A ready-made sleep questionnaire template offers clear clinical and operational advantages over asking about sleep informally.

Clinical benefits: A validated, structured screen catches problems an informal conversation might miss, and gives you an objective score to track over time. A structured patient record with questionnaire scores makes it easy to compare a patient’s results visit to visit.

Workflow benefits: A ready-to-use template removes the need to build your own sleep screen from scratch. Patients can complete it from home or in the waiting room, which frees up staff time and means the score is ready before the clinician walks in.

Documentation benefits: A dated, scored questionnaire in the chart supports your referral decisions and strengthens the record if a patient’s case is reviewed later. It also gives patients a concrete explanation for why you’re recommending a sleep-medicine referral or a sleep study, rather than relying on your impression alone.

Integrating the sleep questionnaire into digital patient management

Paper sleep questionnaires are easy to lose and awkward to score consistently. Digital intake removes both problems.

Automated intake workflows can send the right sleep questionnaire automatically whenever a visit is booked for a fatigue, snoring, or sleep-related concern, so the patient completes it before they arrive and the score is waiting in the chart. That saves the front desk from chasing paper forms and means nothing gets missed on a busy day.

For practices that see a mix of sleep complaints, customizable intake forms let you route the right questionnaire to the right visit type. A snoring or fatigue complaint pulls the ESS or STOP-BANG, while a general sleep-quality or insomnia concern pulls the PSQI or ISI.

Multi-location practices benefit most: a standardized digital template means every clinician screens the same way, and a patient seen at a different site still has their full sleep-screening history available.

See how Pabau streamlines sleep screening

Replace paper sleep questionnaires with automated digital intake forms. Pabau's intake platform captures PSQI, ESS, ISI, and STOP-BANG responses, scores them automatically, and stores results in the patient record so you can track them over time.

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Conclusion

A sleep questionnaire is a brief, validated screen that flags patients at risk of poor sleep quality, excessive daytime sleepiness, insomnia, or obstructive sleep apnea. The PSQI, ESS, ISI, and STOP-BANG each cover a different piece of that picture, and each comes with its own score range and cutoff.

A positive screen on any of them supports the case for further evaluation, whether that’s a closer clinical history, a sleep-medicine referral, or a sleep study, but none of them confirm a diagnosis on their own.

Building sleep screening into digital intake, using patient engagement and compliance tools, keeps screening consistent across visits and reduces the documentation burden on your team. Download the sleep questionnaire template above and start using it at your next visit where sleep is part of the picture.

Continue your research

Need to document a STOP-BANG risk factor like BMI over 35? Our BMI chart template gives you a ready-made way to track it at intake.

Screening for a mood or personality disorder alongside a sleep complaint? The BPD worksheet gives DBT therapists a structured way to track symptoms between sessions.

Tracking hypertension alongside a STOP-BANG screen? A blood pressure log template makes that comorbidity easy to document over time.

Frequently asked questions