ARFP

Autumn Road Family Practice

904 Autumn Road, #200

Little Rock, AR 72211

Sleep/Insomnia Questonaire

Do you have insomnia? This quiz can help describe the severity of your sleep problem.

1. How severe is your difficulty falling asleep?
2. How severe is your difficulty staying asleep?
3. How severe is your problem of waking up too early?
4. How satisfied or dissatisfied are you with your current sleep pattern?
5. To what extent do you consider your sleep problem to interfere with your daily functioning (fatigue, concentration, memory, mood etc)?
6. How noticeable to others do you think your sleeping problem is in terms of impairing the quality of your life?
7. How worried or distressed are you about your current sleep problem?