NOT AT ALL	A LITTLE BIT	SOMEWHAT	MODERATELY	VERY MUCH
1. I go to bed at about the same time every night............................................	□	□	□	□	□
2. It takes me about the same amount of time to fall asleep each night............	□	□	□	□	□
3. I wake up for about the same number of times each night...................	□	□	□	□	□
4. I spend about the same amount of time awake each night..........................	□	□	□	□	□
5. I wake up at about the same time each morning........................................	□	□	□	□	□
6. I get out of bed at about the same time each morning................................	□	□	□	□	□
7. I feel about equally refreshed upon waking up each morning.......................	□	□	□	□	□
8. I am asleep for about the same amount of time every night....................	□	□	□	□	□
9. I take (or do not take) a similar number and duration of naps each day	□	□	□	□	□
10. My sleep on weekdays and weekends is about the same................	□	□	□	□	□