The following questions relate to your usual sleep habits over the last week.
1.	What time do you typically go to bed at night?				Time…………. pm
2.	What time do you typically wake up in the morning?				Time…………. am
3.	On average, how long does it take for you to fall asleep?				……….… mins
The next questions relate to your sleep quality over the last week. Please circle the number of nights/days you experienced the following:
4. Taking more than 30‐minutes to fall asleep at night?
0	1	2	3	4	5	6	7
5. Waking during the night and finding it difficult to fall asleep again?
0	1	2	3	4	5	6	7
6. Waking up too early in the morning and not being able to fall asleep again?
0	1	2	3	4	5	6	7
7. Having vivid dreams, or acting out your dreams (e.g., punching, kicking, screaming)?
0	1	2	3	4	5	6	7
8. Experiencing nightmares or frightening dreams?
0	1	2	3	4	5	6	7
9. Feeling overly sleepy during the day?
0	1	2	3	4	5	6	7
10. Napping during the day?
0	1	2	3	4	5	6	7