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