Start Insomnia Test Step 1 of 9 11% Please rate the current (i.e., last 2 weeks) SEVERITY of your insomnia problem – difficulty staying asleep Not At All Several Days More Than Half the days Nearly Everyday Please rate the current (i.e., last 2 weeks) SEVERITY of your insomnia problem – difficulty falling asleep Not At All Several Days More Than Half the days Nearly Everyday Please rate the current (i.e., last 2 weeks) SEVERITY of your insomnia problem – problem waking up too early Not At All Several Days More Than Half the days Nearly Everyday How satisfied/dissatisfied are you with your current sleep pattern? Not At All Several Days More Than Half the days Nearly Everyday 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, etc.). Not At All Several Days More Than Half the days Nearly Everyday How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life? Not At All Several Days More Than Half the days Nearly Everyday How WORRIED/distressed are you about your current sleep problem? Not At All Several Days More Than Half the days Nearly Everyday Name Email Phone Number Your Test Score