| 1. Do you have difficulty in falling asleep? |
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| 2. Do you have difficulty staying asleep? |
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| 3. Do you have problems waking up too early? |
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| 4. How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? |
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| 5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? |
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| 6. How WORRIED/DISTRESSED are you about your current sleep problem? |
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| 7. 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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