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Free Sleep Quality Check Template

Free PSQI-style sleep quality self-assessment — score seven components from latency to daytime function and get an AI report on your weakest dimension.

~8 min
7 dimensions
AI PDF Report
AI Consultant
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Quick answer

Free PSQI-style sleep quality self-assessment — score seven components from latency to daytime function and get an AI report on your weakest dimension.

Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified professional when needed.

Methodology: items are a structural adaptation of widely used frameworks, not an official version; scoring is indicative, not diagnostic.

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About this template

Sleep problems rarely arrive alone — they drag daytime energy, focus and mood with them. This PSQI-style check scores seven components from latency and disturbance to daytime dysfunction, and its AI report highlights the weakest dimension so therapy or CBT-I conversations start with the actual problem instead of vague bad sleep nights.

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Live Preview

Sample form and AI report preview (fillable once the app is published).

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Fill it in to see how responses flow.
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Sample AI report with scoring visuals and recommendations, printable as a PDF.
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Scan the QR on the report to start an AI consultant chat.
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What's Included

The PSQI-style duration, quality and disturbance components.

1

Seven sleep dimensions

The classic PSQI-style component framing in self-report wording.

2

Component radar report

AI PDF shows which sleep dimension is the weak link.

3

Daytime-impact emphasis

Functioning items keep the check practical, not clinical.

4

Session-ready output

Bring the report to a sleep-focused or CBT-I conversation.

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How It Works

From copy to a sleep-quality band in four steps.

1

Copy the template

Import the check with scoring and report — free.

2

Adjust the window

Change recall period or add nap and shift-work items.

3

Clients complete it

Eight minutes, evening or morning, on any device.

4

Read the profile

Use the weakest dimensions to plan the sleep session agenda.

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Who Is This For

Who screens — clients, clinicians or wellness programs.

1

Therapists & sleep-focused clinicians

Start CBT-I work with a structured self-report baseline.

2

Individuals debugging sleep

Find whether latency, disturbance or daytime drag dominates.

3

Occupational health teams

Screen sleep load behind fatigue complaints, indicative only.

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Key Features

What makes this sleep check explain what disturbs rest.

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Sample Questions Inside

The seven PSQI-style components — the live check converts answers into indicative component scores and an AI sleep report.

  1. Overall, how would you rate your sleep quality in the last month? (1-5)
  2. How long do you usually take to fall asleep? (1-5)
  3. How often do you wake during the night or too early? (1-5)
  4. How much do sleep problems affect daytime energy and focus? (1-5)
  5. Do you use medication or supplements to sleep? (frequency)
  6. What disturbs your sleep most — noise, worry, schedule? (open)
  7. When would you like to work on sleep? (open)
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Frequently Asked Questions

Is this the official PSQI?
No — it is a structural adaptation of the widely used seven-component Pittsburgh framing with rewritten items; the official PSQI requires publisher permission, and scores here are indicative.
Which sleep dimension matters most?
There is no universal answer — the report highlights your weakest components, and daytime dysfunction is often the one worth targeting first in therapy.
Can this replace a sleep study?
No. It self-reports patterns; suspected sleep apnea or medical sleep disorders need clinical evaluation.
Is it free to use?
Yes — copy the check, scoring and AI report into your FormLM workspace at no cost.
How often should the sleep check be retaken?
Every two to four weeks during sleep-focused work; compare component profiles rather than single totals.
Does the AI report give sleep advice?
It summarizes your pattern and suggests topics to bring to a professional — it does not prescribe or diagnose.

Find the weak link in your sleep

A PSQI-style check with a seven-dimension AI report — free to copy and share.