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Patients with amyotrophic lateral sclerosis (ALS) have poor sleep quality, but little is known about which factors affect sleep at time of diagnosis.Patients with newly diagnosed ALS were administered the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, Beck Depression Inventory–Revised, and ALS Functional Rating Scale and were compared with controls.Forty-three patients, age 63.8 ± 11.5 years, ALS Functional Rating Scale 30.7 ± 5.0. Poor sleep quality was frequent: 27 (63%) patients had PSQI >5 compared with 16 (37%) controls (P = 0.031); with higher PSQI (7.1 ± 4.1 vs. 4.7 ± 2.8, P = 0.003). PSQI correlated with Beck Depression Inventory–Revised (r = 0.344, P = 0.024) and inability to turn in bed (r = −0.335, P = 0.033).Patients with newly diagnosed ALS have poor sleep quality, which is associated with depression and difficulty turning in bed. Longitudinal studies to examine the evolution of sleep quality and the effectiveness of individualized interventions are needed in patients with ALS.