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ereHEALTH

Important

This is a validated screening tool, not a diagnosis. Only a qualified provider can make a clinical diagnosis. Your responses are not stored or shared — this screening is completely private.

1. How difficult is it for you to fall asleep?
2. How difficult is it for you to stay asleep?
3. How much of a problem do you have with waking up too early?
4. How satisfied/dissatisfied are you with your current sleep pattern?
5. To what extent do you consider your sleep problem to interfere with your daily functioning (e.g., daytime fatigue, ability to function at work/daily chores, concentration, memory, mood)?
6. How noticeable to others do you think your sleep problem is in terms of impairing the quality of your life?
7. How worried/distressed are you about your current sleep problem?