What your PROMIS Sleep Disturbance score really means

You answered eight questions about your sleep quality and got a T-score. The PROMIS Sleep Disturbance assessment focuses on your nighttime sleep experience, not how tired you feel during the day, but how well you're actually sleeping. Here's what your score tells you.

The quick answer

The key threshold is 55. Below this, your sleep quality is within normal limits. Above it, you're experiencing more sleep disturbance than most people.

Understanding your T-score

T-scores let you compare yourself to others:

T = 50: Average. Half the reference population sleeps better, half sleeps worse.

T = 60: One standard deviation above average for disturbance. You're experiencing more sleep problems than about 84% of people.

T = 70: Two standard deviations above average. Your sleep is more disturbed than about 98% of people. This is clearly abnormal.

T = 40: One standard deviation below average. You're sleeping better than most.

A note on the reference population

Unlike most PROMIS measures, the sleep scales weren't calibrated on a nationally representative sample. The reference group was enriched for chronic illness. This means if you're generally healthy, your T-score might appear slightly higher than if compared to the general population. A score of 52 in this context is solidly normal.

What this assessment measures

This assessment asks about your nighttime sleep experience, not daytime functioning. It covers:

- How you'd rate your overall sleep quality
- Whether your sleep feels refreshing
- Whether you perceive problems with your sleep
- Difficulty falling asleep
- Restless sleep
- Having to try hard to get to sleep
- Worrying about not being able to fall asleep
- Whether you're satisfied with your sleep

If you want to know how poor sleep affects your daytime functioning, the PROMIS Sleep-Related Impairment is the companion measure for that.

What your specific score suggests

T-score below 50 (better than average)

Your sleep quality is better than the reference population. You're falling asleep without much difficulty, sleeping through the night reasonably well, and waking up feeling refreshed. No concerns here.

T-score 50-54 (average range)

Your sleep quality is typical. Some nights are better than others, occasional difficulty falling asleep, perhaps not always waking fully refreshed. This is normal life.

T-score 55-59 (mild disturbance)

You're experiencing more sleep problems than most. You might:
- Take longer to fall asleep than you'd like
- Sleep somewhat restlessly
- Wake up not feeling fully refreshed
- Have some nights significantly worse than others

This level often prompts people to start thinking about their sleep habits.

T-score 60-69 (moderate disturbance)

Your sleep quality is significantly impaired. You likely:
- Frequently have difficulty falling asleep
- Experience restless or fragmented sleep
- Rarely wake up feeling refreshed
- May worry about sleep, which makes it harder
- Probably notice the impact on your days

At this level, addressing the issue is worthwhile. The disturbance is real, not imagined.

T-score 70+ (severe disturbance)

Fewer than 2% of people experience this level of sleep disturbance. You're likely:
- Struggling significantly to fall asleep most nights
- Having very poor quality sleep when you do sleep
- Waking unrefreshed consistently
- Possibly spending considerable time worrying about sleep
- Experiencing clear impact on daily life

A score this high warrants evaluation. This could indicate insomnia disorder, another sleep disorder, or an underlying condition affecting sleep.

The eight questions explained

"My sleep quality was..." (Very poor to Very good)

This is your global assessment, integrating everything about your sleep into one overall rating. How would you grade your sleep?

"My sleep was refreshing" (reverse-scored)

Refreshing sleep means waking up restored. You can sleep 8 hours and still wake exhausted if the sleep isn't restorative. This happens with sleep apnea, for example, or with very fragmented sleep.

"I had a problem with my sleep"

A catch-all question. Do you perceive your sleep as problematic, whatever the specific issue?

"I had difficulty falling asleep"

Sleep onset insomnia, or trouble transitioning from awake to asleep. This is one of the most common sleep complaints. Normal sleep onset is under 20-30 minutes.

"My sleep was restless"

Quality matters, not just quantity. Restless sleep (tossing, turning, frequent position changes, light sleep) doesn't provide proper restoration even if duration seems adequate.

"I tried hard to get to sleep"

Here's a paradox: trying hard to sleep often prevents sleep. Sleep comes naturally when conditions are right. If you're efforting toward sleep, something's wrong.

"I worried about not being able to fall asleep"

Sleep anxiety is self-perpetuating. You worry about not sleeping, which activates your nervous system, which makes sleep harder, which increases worry. This is a core feature of chronic insomnia.

"I was satisfied with my sleep" (reverse-scored)

Are your needs being met? Satisfaction is subjective. Some people need more sleep than others, some are more tolerant of imperfect sleep. But if you're dissatisfied, that matters.

Common patterns

Sleep onset problems (high on Q4, Q6, Q7)

If your main issues are difficulty falling asleep, trying hard to sleep, and worrying about sleep, you're describing classic insomnia symptoms. The worry and effort create a vicious cycle. Cognitive behavioral therapy for insomnia (CBT-I) specifically targets this pattern.

Poor sleep quality (high on Q1, Q2, Q5, Q8)

If your main issues are overall quality, non-refreshing sleep, restless sleep, and dissatisfaction, but falling asleep isn't the problem, something may be disrupting your sleep after you fall asleep. Sleep apnea, periodic limb movements, or other disorders can cause this pattern.

Both patterns

Many people have both onset and quality problems. A full sleep evaluation may be warranted.

Sleep Disturbance vs. Sleep-Related Impairment

PROMIS offers two sleep measures:

Sleep Disturbance (this assessment): How well are you sleeping at night?

Sleep-Related Impairment: How much is poor sleep affecting your daytime functioning?

These don't always match:
- Some people sleep poorly but cope well during the day (high Disturbance, normal Impairment)
- Some people sleep okay but still feel impaired (normal Disturbance, high Impairment, suggesting another cause for fatigue)
- Many have both elevated (poor sleep causing daytime problems)

Taking both gives a complete picture.

What to do based on your score

If your score is below 55

Your sleep quality is normal. If you're still curious about optimizing sleep, standard sleep hygiene recommendations apply, but you're not in clinical territory.

If your score is 55-59

Consider whether sleep hygiene basics might help:
- Consistent sleep schedule (even weekends)
- Cool, dark, quiet sleep environment
- Limiting screens before bed
- Avoiding caffeine after early afternoon
- Regular exercise (but not right before bed)

If your score is 60-69

Sleep hygiene alone may not be enough. Consider:
- Talking to a healthcare provider
- Asking about CBT-I (cognitive behavioral therapy for insomnia)
- Keeping a sleep diary to identify patterns
- Evaluating for underlying conditions (anxiety, depression, pain)

If your score is 70+

See a healthcare provider. This level of disturbance suggests:
- Possible insomnia disorder requiring treatment
- Need to rule out other sleep disorders (apnea, restless legs)
- Evaluation for conditions affecting sleep
- Likely benefit from structured intervention

Common questions

I sleep 8 hours but still score high. Why?

Sleep duration isn't everything. You can spend 8 hours in bed and have poor-quality sleep: light, restless, fragmented. The assessment measures quality, not just quantity.

My partner says I sleep fine. Why is my score elevated?

The assessment captures your subjective experience. You may perceive your sleep as more disturbed than it appears from outside. Alternatively, subtle issues (like brief awakenings) may not be visible to a partner but affect your experience.

Can I compare my score to someone else's?

Yes, that's the point of T-scores. If you're at 62 and your spouse is at 45, you're experiencing significantly more sleep disturbance. Whether that's due to different biology, different sleep disorders, or different circumstances varies.

How often should I retake this?

If tracking a sleep intervention, every 2-4 weeks is reasonable. The 7-day recall window means you're capturing recent sleep, not long-term patterns.

The bottom line

Your PROMIS Sleep Disturbance score tells you how your sleep quality compares to others. Scores below 55 are normal. Scores of 55-59 suggest mild disturbance worth monitoring. Scores of 60+ indicate significant problems that likely warrant attention, whether that's improved sleep hygiene, evaluation for sleep disorders, or treatment like CBT-I. The score measures the nighttime sleep experience, not daytime consequences. For a complete picture, consider the companion PROMIS Sleep-Related Impairment assessment as well.