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Sleep Questionnaire
Email address
First Name
Last Name
Gender
Age (years)
Do you have trouble falling asleep at night?
Do you find it difficult to stay asleep?
Do you sleep less than 7 hours a night?
Time
:
Do you require noise to fall asleep "white noise"?
Do you require absolute silence to stay/fall asleep?
Are you woken easily (i.e. "light sleeper")
Do you often wake up in the middle of the night?
Do you wake up feeling fatigued?
Do you rely on an alarm to wake up?
Do you rely on medications to get a better night's sleep?
Do you consume more than 3 caffeinated beverages a day?
Do you consume caffeine after 1 pm?
Do you drink more than two alcoholic beverages in the evening?
Do you find it easier to fall asleep after drinking alcohol?
Do you find that you can't fall asleep after drinking alcohol?
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