Insomnia test (MISS): a private 1-minute sleep self-check

Insomnia means regularly having trouble falling asleep or staying asleep, or sleep that does not leave you rested.⁴ The Minimal Insomnia Symptom Scale (MISS) asks about these three core symptoms:¹

• difficulty falling asleep;
• waking up during the night;
• not feeling rested after sleep.

For each one, you choose how much of a problem it is for you, from “None” to “Very severe”. The scale does not ask about a fixed time period, and it does not ask how many hours you sleep: it is about how much your sleep troubles you.¹

Each answer scores from 0 (“None”) to 4 (“Very severe”), so the total runs from 0 to 12.

In the original study of more than 1,000 adults aged 20 to 64 in Sweden, a total of 6 or more picked up 82% of people with clinical insomnia and correctly ruled out 86% of those without it.¹ A later study in older adults found that a cut-off of 7 worked better for that age group.²

A total of 6 or more means your sleep problems are at the level that was linked with clinical insomnia in research. It is not a diagnosis. In the general population, fewer than half of the people who scored 6 or more turned out to have clinical insomnia, so a high score is a reason to look more closely, not proof.¹

A total below 6 does not mean your sleep problems are not real. If poor sleep bothers you, it is worth paying attention to, whatever the score.

Many things can disturb sleep, including stress and worry, low mood, pain, caffeine, irregular working hours and screens late at night, and worrying about sleep can itself keep insomnia going.⁵ The MISS is too short to describe your sleep fully, and its authors note that it cannot be used to make a diagnosis.¹

The treatment with the strongest evidence for long-term insomnia is cognitive behavioural therapy for insomnia (CBT-I), a structured talking therapy that changes the habits and worries that keep poor sleep going. Good sleep habits help too, but on their own they are usually not enough to treat insomnia.³ You can start with these steps:

• Get up at the same time every day, including weekends, even after a bad night.
• Go to bed only when you feel sleepy, not just because it is bedtime.
• If you cannot sleep, get up. Do something calm in dim light, and go back to bed when you feel sleepy.
• Keep the bed for sleep. Avoid working, scrolling or watching videos in bed.
• Cut down on tea, coffee and energy drinks in the afternoon and evening.
• Deal with worries earlier. Write them down, with a plan for tomorrow, before your wind-down time.

Sleeping pills are usually only for a few days or weeks, because they can cause side effects and dependence.⁴ Never start, stop or change a medicine without talking to a doctor. Our guide to better sleep habits has more ideas.

See a doctor or a qualified professional — a BMDC-registered psychiatrist or a clinical psychologist — if:

• poor sleep has lasted for several weeks, or keeps coming back;
• tiredness affects your work, study, driving or relationships;
• you snore loudly, someone has noticed pauses in your breathing at night, or you feel very sleepy during the day;
• you also feel low, anxious or on edge most of the time;
• you rely on sleeping pills, alcohol or other substances to sleep.

Care is available in private practice and at public hospitals.

The Minimal Insomnia Symptom Scale was developed by Jan-Erik Broman, Hans Smedje, Lena Mallon and Jerker Hetta in Sweden, and published in 2008 in the Upsala Journal of Medical Sciences.¹ Its three questions come from the Uppsala Sleep Inventory, a longer sleep questionnaire used in many studies. The article is published under a Creative Commons CC BY 4.0 licence, which allows anyone to use the scale with credit to the authors.

The MISS was developed and tested in Sweden, and there is no validated Bangla version yet. We never translate a validated questionnaire ourselves, so our Bangla page shows the English questions. A Bangla version will be added only when a properly translated and tested version is available.