| Answer the following questions if this applies to you more than one night a week: | Print Page |
| 1. Do you have trouble falling asleep at night? | ||
| 2. Do you have difficulty waking up in the morning? | ||
| 3. Do you sleep less than 8-9 hours a night? | ||
| 4. Do you wake up once or more during the night? | ||
| 5. Do you sleep in a room with any light or noise? | ||
| 6. Do you wake up feeling tired? | ||
| 7. Do you wake up only with an alarm? | ||
| 8. Do you go to bed later than 11 pm? | ||
| 9. Do you get up earlier than 6 am? | ||
| 10. Do you use medications (OTC or RX) for sleep? |