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The Insomnia Severity Index (ISI) measures insomnia severity [ 16].
In terms of outcome measures, insomnia RCTs generally find larger effects of treatment on subjective measures such as questionnaires than on objective measures of actigraphy and polysomnography.
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The Insomnia Severity Index (ISI) is a valid and reliable tool for measuring insomnia [ 20- 22].
Several tools for measuring insomnia have been developed [ 6- 9] reflecting the growing interest and need for assessment instruments in insomnia research.
Psychological distress was assessed in the survey with an 11-item four-point scale measuring insomnia, depressive symptoms, tension and anxiety [ 29, 30].
The Insomnia Severity Index (ISI) [ 6] is the most established instrument for measuring insomnia symptoms, however there is only one out of 7 items that targets the psychological symptoms, namely being worried about the current sleep pattern.
However, we only measured insomnia on one occasion, and as sleep problems commonly fluctuate over time, it would be better to have repeated measurements over a long time period in order to identify chronic insomniacs.
The Metacognitions Questionnaire-Insomnia (MSQ-I) [ 26] and the Dysfunctional and Attitudes about Sleep scale [ 27] have been developed to measure insomnia-specific worrisome thoughts and beliefs.
These data suggest that objective sleep measures in insomnia provide an index of the severity of the disorder and that the more severe form of insomnia is most likely associated with morbidity and possibly mortality.
The ISI demonstrated acceptable internal consistency reliability (α ≥ .85) and validity as evidenced by correlation with other subjective and objective measures of insomnia severity [ 34].
Even so, nightly melatonin supplementation, alone or combined with magnesium (which also improves measures of insomnia), 49 has been shown to improve sleep disturbance in older adults 50– 52 as well as to diminish symptoms of REM sleep behavior disorder.
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