Consumer - Insomnia Score Card - Medicines India

We can help you learn more about your dizziness. Please complete the questionnaire till the end so we can generate your Insomnia Score and best help you assess your symptoms.

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Q1. Gender:

Male Female Other None

Q2. Age:

18-24 25-34 35-44 45-54 55+ None

Q3. How often do you find it difficult to fall asleep?

Never Once a week 2-4 days a week 4-7 days a week None

Q4. How often do you find it difficult to stay asleep at night?

Never Once a week 2-4 days a week 4-7 days a week None

Q5. How often do you wake up early in the morning?

Never Once a week 2–4 days a week 4–7 days a week None

Q6. How often in a week do you sleep for less than 6 hours in the night?

Never Once a week 2-4 days a week 4-7 days a week None

Q7. For how long have you had difficulty in sleeping?

Never Less than 3 months More than 3 months None

Q8. Has sleep problem affected your overall quality of life?

Not affected Moderately affected Severely affected None

Q9. How often do sleep problems impair your mood during the day, i.e., make you feel irritable or distressed?

Never Once a week 2-4 days a week 4-7 days a week None

Q10. How often do you feel tired or fatigued during the day because of your sleep problem?

Never Once a week 2-4 days a week 4-7 days a week None

Q11. How often does the sleep problem impair your ability to concentrate, think and take decisions?

Never Once a week 2-4 days a week 4-7 days a week None

Q12. How often do you take sleeping supplements to help you sleep?

Never Once a month Once a week More than 3 times a week None

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प्र1. लिंग:

पुरुष स्त्री अन्य None

प्र2. आयु:

18-24 25-34 35-44 45-54 55+ None

प्र3. कितनी बार आपको नींद मुश्किल से आती है?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र4. कितनी बार आपको रात में सोये रहना मुश्किल लगता है?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र5. कितनी बार आप सुबह जल्दी उठ जाते हैं?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र6. सप्ताह में कितनी बार आप रात को 6 घंटे से कम सोते हैं?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र7. आपको कितने समय से नींद न आने की परेशानी है?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र8. क्या नींद की समस्या से आपकी कुल जीवनस्तर प्रभावित हुआ है?

नहीं हुआ है मध्यम प्रभाव गंभीर प्रभाव None

प्र9. दिन में कितनी बार नींद की समस्या के कारण आपकी मनोदशा ख़राब होती है यानि कि आपको चिड़चिड़ाहट या तनाव महसूस होता है?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र10. कितनी बार आपकी नींद की समस्या के कारण आपको दिन में थकान या सुस्ती महसूस होती है?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र11. कितनी बार नींद की समस्या आपकी एकाग्रता, सोचने की और फैसले लेने की शक्ति को प्रभावित करती है?

कभी नहीं सप्ताह में एक बार सप्ताह में 2-4 दिन सप्ताह में 4-7 दिन None

प्र12. कितनी बार आपको नींद के लिये सहायता लेनी पड़ती है?

कभी नहीं महीने में एक बार सप्ताह में एक बार सप्ताह में 3 बार None

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Reference Citation: Modified from ‘Bhatia M. Development and Validation of a Questionnaire to Assess Insomnia in Indian Setting. J Assoc Physicians India. 2020 Jan;68(1):68’.

Disclaimer: “This patient information material is meant for the awareness and information of patients only and not to be construed as a substitute to a doctor’s advice. Although due care has been taken to ensure the accuracy and completeness of the information, Abbott India Limited shall not be liable in any manner whatsoever for any action on the basis of this patient information material and does not hold itself liable for any consequences, legal or otherwise, arising out of information in this patient information material”

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