*PROMIS—Sleep Disturbance—Short Form
Instructions to patient: On the DSM-5 Level 1 cross-cutting questionnaire that you just completed, you indicated that during the past
2 weeks you (the individual receiving care) have been bothered by “problems with sleep that affected your sleep quality over all” at a mild or greater level of severity. The questions below ask about these feelings in more detail and especially how often you (the
individual receiving care) have been bothered by a list of symptoms during the past 7 days. Please respond to each item by marking (1-5) one box per row.
In the past seven (7) days
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