17:48, 13/09/2022 Online Survey Software | Qualtrics Survey Solutions

The following questions are related to your current sleep patterns and potential sleep
problems over the last 2 weeks. 
 
Please answer each question honestly. There are no right or wrong answers. 

  Not at all A little Somewhat Much Very much

S1. How satisfied are
you with your current
sleep pattern?
S2. How noticeable to
others do you think
your sleep pattern is in
terms of impairing the
quality of your life?
S3. How
worried/distressed are
you with your current
sleep pattern?
S4. To what extent do
you consider your
sleep pattern to
interfere with your daily
functioning currently
(e.g. daytime fatigue,
mood, ability to work,
memory, etc)?

Please rate the current severity (i.e. over the last 2 weeks) of your insomnia problems:

  None Mild Moderate Severe Very severe

S5. Difficulty falling
asleep
S6. Difficulty staying
asleep
S7. Problem waking up
too early

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