Rudi Hayden

Self-Assessments

Please answer every question.

Over the past two weeks or more, how often have you experienced or been concerned about any of the following statements?

Question	Almost Never	Sometimes	Often	Very Often
1: I have trouble falling asleep at bedtime
2: When I can’t sleep, I worry that I won’t be able to fall asleep
3: When I wake during the night, I have trouble going back to sleep
4: Some nights I hardly sleep at all, no matter how hard I try
5: When I try to go to sleep, my mind becomes pre-occupied by many new thoughts
6: Trying to fall asleep makes me anxious
7: Pain often wakes me during the night, or prevents me from going back to sleep
8: I believe that the quality of my sleep is poor
9: I feel sleepy during the day as result of my poor sleeping patterns
10: I feel desperate, distressed or deeply disillusioned about my poor sleeping habits
11: I become very sleepy during the day
12: I have sometimes fallen asleep at inappropriate times during the day, such as whilst driving or during a conversation or at work