COSMIN database

Measurement of non-restorative sleep in insomnia: A review of the literature

Vernon, M. K., Dugar, A., Revicki, D., Treglia, M., and Buysse, D.
OBJECTIVE: Non-restorative sleep (NRS) is a core symptom of insomnia, typically defined as a subjective feeling of being unrefreshed upon awakening. NRS symptoms have been less consistently studied than other symptoms of insomnia, and there is no consensus regarding measurement of NRS. Given its subjective nature, patient-reported outcome (PRO) instruments are important for evaluating NRS symptom severity and treatment-related changes. The objective of this literature review was to identify PROs used in insomnia populations that purport to measure NRS, and to evaluate their psychometric characteristics.

METHODS: A comprehensive review of PRO instruments used in insomnia was conducted; instruments were reviewed for NRS content by two independent reviewers; a total of 26 instruments identified to contain NRS content were retained for further review.

RESULTS: Of the 26 instruments reviewed, 23 contained at least one item evaluating subjective nighttime aspects of NRS; 17 contained at least one item evaluating daytime aspects of NRS. Only the Sleep Assessment Questionnaire contained a specific NRS domain score. However, little published evidence was available regarding measurement properties of the NRS domain in insomnia populations.

CONCLUSIONS: There is currently no reliable and well-validated PRO instrument available for specifically evaluating NRS symptom severity and response to interventions in insomnia populations. Reliable and valid measurement tools are needed to measure the symptom of NRS in insomnia.
Sleep Med Rev
1532-2955 (Electronic)
Publication year:
Symptom status:
Physical state
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the nervous system
Mental and behavioural disorders and related symptoms
PRO / non-PRO:
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
2 - Interviews
3 - Diaries
AIS - Athens Insomnia Scale
Angst's questions
BNSQ - Basic Nordic Sleep Questionnaire
CIDI - Composite International Diagnostic Interview
GSDS - General Sleep Disturbance Scale
John's instrument
JSPS - Jenkins Sleep Problems Scale
KSD - Karolinska Sleepiness Diary
LDSD - Lacks' Daily Sleep Diary
LSEQ - Leeds Sleep Evaluation Questionnaire
MOS-Sleep - Medical Outcomes Study Sleep Scale
PIRS - Pittsburgh Insomnia Rating Scale
PMQ - Patient Morning Questionnaire
Post-Sleep Inventory
PSD - Pittsburgh Sleep Diary
PSEQ - Post-Sleep Evaluation Questionnaire
PSQI - Pittsburgh Sleep Quality Index
PSQ - Post-Sleep Questionnaire
QOLI - Quality of Life of Insomniacs
SAQ - Sleep Assessment Questionnaire
SISQ - Spielman Insomnia Symptom Questionnaire
Sleep-EVAL system
SMHSQ - St. Mary’s Hospital Sleep Questionnaire
Subjective Evaluation of Sleep
VSH Sleep Scale - Verran and Snyder-Halpern Sleep Scale
WHIIRS - Women’s Health Initiative Insomnia Rating Scale