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1
How many days a week has it taken you more than 30 minutes to fall asleep after the light was switched off?
2
How many days a week have you been awake for more than 30 minutes between periods of sleep?
3
How many days a week have you awakened more than 30 minutes earlier than you wished without managing to fall asleep again?
4
How many days a week have you felt that you have not had enough rest after waking up?
5
How many days a week have you been so sleepy/tired that it has affected you at school/work or in your private life?
6
How many days a week have you been dissatisfied with your sleep?
The presented answer sheet is not an original form and is not intended for printing or use as a handout.