| Over the last 2 weeks, how often have you been bothered by the following problems? |
| Do you have difficulty falling asleep? |
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| Do you have difficulty staying asleep? |
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| Do you have problems waking up too early? |
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| How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? |
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| How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? |
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| How WORRIED/DISTRESSED are you about your current sleep problem? |
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| To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY? |
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