Patient: Age: Weight:

Sleep PSQ-3


Measure Sleep

PSQ-3: Questionnaire for Pain and Sleep

Completed by:
Patient or Clinician

Purpose:
To screen for sleep disturbance related to pain

Questionnaire:

Thinking back over the last week, how has pain affected your sleep? For each of the following questions, drag the slider to the point you feel applies to you.

Never Always

Never Always

Never Always


Total Score:
Scoring:
The VAS score is determined by measuring in millimetres from the left hand end of the line to the point that the respondent marks on the line.

Scoring of the PSQ-3 consists of the algebraic sum of items 1-3.

How to Interpret Score:
  • Score will be between 0-300
  • The higher the score, the more the patient's pain is interfering with their sleep

Reference: Ayearst, L.E., Harsanyi, Z., & Michalko, K.J. (2012). The Pain and Sleep Questionnaire 3-item index (PSQ-3): A reliable and valid measure of the impact of pain on sleep in chronic non-malignant pain of various etiologies. Pain Research & Management, 17, 281-290.

Link to Abstract: http://www.ncbi.nlm.nih.gov/pubmed/22891194


Improving Your Sleep

Tips for making your sleep better.
http://umm.edu/programs/sleep/patients/sleep-hygiene

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