- Answer every item for a typical night over the past month, not just last night.
- For the frequency selects, the scale is fixed: 0 = not during the past month, 1 = less than once a week, 2 = once or twice a week, 3 = three or more times a week.
- Enter minutes to fall asleep, hours of actual sleep, and hours spent in bed (bedtime to final wake-up) for components 2, 3, and 4.
- The result shows the global PSQI (0–21), the computed sleep efficiency (%), and a good (≤5) / poor (>5) verdict with next-step guidance.
- This is a practical implementation of the PSQI components: the full instrument sums 9 sub-items in component 5 and uses paired bed/wake times — here those are condensed to usable single inputs while preserving the 0–3 component scoring and the 0–21 global range.
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When to Use
Use the PSQI to quantify subjective sleep quality over the preceding month in patients where poor sleep is plausibly driving symptoms or quality of life. It is especially relevant in CKD and dialysis populations, where the prevalence of poor sleep is high and overlapping contributors — obstructive sleep apnea, restless legs syndrome, uremic pruritus, depression, and the disruption of in-center hemodialysis schedules — are common and frequently treatable.
Appropriate use
Screening and longitudinal tracking of subjective sleep quality in adults, including HD/PD patients and pre-dialysis CKD. A global score >5 flags a clinically meaningful sleep complaint warranting evaluation. Pairs naturally with the STOP-BANG OSA screen and the PHQ-9 depression screen.
When NOT to rely on it alone
The PSQI is a subjective questionnaire, not a diagnostic test. It does not diagnose OSA, RLS, or any specific sleep disorder and cannot replace a sleep study (polysomnography) where one is indicated. A "good" global score does not exclude significant OSA. Interpret it as a symptom measure that directs further workup, not an endpoint.
Pearls & Pitfalls
Global >5 means look harder
A global PSQI >5 distinguishes poor from good sleepers with high sensitivity and specificity in the original validation. In a dialysis patient, a positive screen should prompt a structured search for OSA (STOP-BANG, sleep study), restless legs (often uremic — check ferritin/transferrin saturation and replace iron), nocturnal pruritus, depression (PHQ-9), and dialysis-schedule or caffeine/sleep-hygiene factors.
Restless legs and iron in CKD
RLS is markedly more prevalent in CKD and on dialysis and is a major, under-recognized driver of poor PSQI scores. It frequently responds to iron repletion (target transferrin saturation and ferritin) and to treating uremia, so a high disturbance/daytime-dysfunction score should trigger an iron-status check before reaching for hypnotics.
Pitfalls
(1) This is a practical, condensed implementation — the full PSQI sums 9 disturbance sub-items and derives latency/efficiency from paired clock times; component scores here approximate, not reproduce, every granular item. (2) Recall bias affects any "past month" self-report. (3) Watch for divide-by-zero / blank fields — efficiency is only computed when hours in bed is entered and >0. (4) A normal score does not rule out OSA or RLS. (5) Avoid normalizing chronic hypnotic use; treat the underlying cause.
Why Use It
Sleep disturbance is one of the strongest, most modifiable drivers of quality of life in dialysis patients, yet it is easy to overlook in a busy renal clinic. A brief, structured, repeatable score converts a vague "I don't sleep well" into a tracked number that flags the need for an OSA/RLS/depression workup and lets you measure the impact of an intervention (CPAP, iron repletion, schedule change, treating pruritus, sleep hygiene). Used alongside STOP-BANG and PHQ-9, the PSQI completes a practical sleep-and-mood screening set for the CKD population.
Pittsburgh Sleep Quality Index (PSQI) Calculator
Answer each item for a typical night over the past month. The tool computes the 7 component scores (each 0–3), the global PSQI (0–21), and your sleep efficiency, then returns a good/poor verdict. Frequency selects use the PSQI scale: 0 = not in the past month, 1 = <1×/week, 2 = 1–2×/week, 3 = ≥3×/week.
⚕ Practical PSQI: 7 components (C1 quality; C2 latency = map[minutes-band + frequency, 0–6]; C3 duration; C4 efficiency = sleep÷in-bed×100; C5 disturbances; C6 medication; C7 daytime = map[sleepiness + enthusiasm, 0–6]), each 0–3, summed to a global score 0–21. Global >5 = poor sleep quality. This is a usable condensation of the full instrument (which sums 9 disturbance sub-items and uses paired clock times) — it is a subjective screen, not diagnostic. Source: Buysse DJ, et al. Psychiatry Res. 1989;28(2):193–213.
Next Steps
Use the global score to direct a targeted workup — it is a screen, not a diagnosis.
- Global ≤5 (good): reassure; recap sleep hygiene; re-screen if new fatigue, mood change, or daytime sleepiness emerges.
- Global >5 (poor): screen for obstructive sleep apnea (STOP-BANG; consider a sleep study) and for depression (PHQ-9 / mental-health guide).
- Restless legs: common and often uremic in CKD/dialysis — check iron status (ferritin, transferrin saturation) and replace iron; treat uremia.
- Uremic pruritus: nocturnal itch fragments sleep — optimize dialysis adequacy, phosphate/PTH control, and consider targeted antipruritic therapy.
- Dialysis-specific factors: review the HD schedule and shift timing, intradialytic napping, post-dialysis fatigue, and caffeine intake; reinforce sleep hygiene.
- Track the global score over time to gauge the impact of an intervention (CPAP, iron, schedule change, treating itch).
Evidence & References
Component scoring (each 0–3)
| Component | Scoring rule |
|---|---|
| C1 Sleep quality | Very good 0 · Fairly good 1 · Fairly bad 2 · Very bad 3 |
| C2 Sleep latency | Minutes band (≤15→0, 16–30→1, 31–60→2, >60→3) + "can't sleep in 30 min" frequency (0–3); sum 0–6 → 0→0, 1–2→1, 3–4→2, 5–6→3 |
| C3 Sleep duration | >7 h → 0 · 6–7 h → 1 · 5–6 h → 2 · <5 h → 3 |
| C4 Sleep efficiency | (actual sleep ÷ hours in bed × 100): ≥85% → 0 · 75–84% → 1 · 65–74% → 2 · <65% → 3 |
| C5 Sleep disturbances | Representative disruption frequency 0–3 (mapped directly) |
| C6 Sleep medication | Frequency 0–3 (mapped directly) |
| C7 Daytime dysfunction | Trouble staying awake (0–3) + lack of enthusiasm (0–3); sum 0–6 → 0→0, 1–2→1, 3–4→2, 5–6→3 |
Global score interpretation
| Global PSQI | Interpretation |
|---|---|
| 0–5 | Good sleep quality |
| > 5 | Poor sleep quality — evaluate for OSA, RLS, depression, uremic pruritus, and dialysis/lifestyle factors |
This is a practical implementation of the PSQI components. The full instrument sums 9 sub-items for component 5 and derives latency and efficiency from paired bedtime/wake-time clock entries; the global >5 cut-off and 0–21 range are preserved here. It is a subjective screen and not diagnostic.
Evidence & References
The PSQI was published in 1989 and validated against poor versus good sleepers, with a global cut-off of 5 distinguishing the two with high sensitivity and specificity. Poor sleep quality and restless legs syndrome are notably more prevalent in dialysis populations than in the general population, and overlapping contributors (OSA, RLS, depression, uremic pruritus, and dialysis schedules) are frequently identifiable and treatable.
- Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
- Maung SC, El Sara A, Chapman C, Cohen D, Cukor D. Sleep disorders and chronic kidney disease. World J Nephrol. 2016;5(3):224–232.
- Merlino G, Piani A, Dolso P, et al. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21(1):184–190.
