Tell Us About Your Sleep

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* 1. How often do you have trouble sleeping?

Almost every night, dammit

A few nights a week

A few nights a month

Almost never, I snooze like a baby

Other (please specify)

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* 2. On average, how much sleep to you get per night?

Three hours or less

Four to five hours

Six to seven hours

Eight hours or more

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* 3. Are you sleeping better or worse than you were 10 years ago?

Better

About the same

Worse

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* 4. What keeps you from sleeping well? Check all that apply.

Night sweats

Body aches and pains

Noisy environment

Partner's snoring

Sleep apnea

Other medical conditions or illnesses

Bad dreams

Anxiety about my family

Anxiety about money or job

Anxiety about sleep itself

Anxiety about the country and the world

A general sense of dread

Brain won't shut down

PTSD

No problem sleeping

Other (please specify)

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* 5. Which of the following best describes your main sleep issue?

I have trouble falling asleep at night

I have trouble staying asleep.

I wake up too early and can't get back to sleep

I wake up several times during the night, making for choppy sleep

I have very light sleep, so I never feel entirely rested

Other (please specify)

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* 6. How much does your sleep issue impact the quality of your life?

Hardly at all

Minor annoyance

Frequent problem

Major disturbance

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* 7. How do you treat your sleep problems? Check all that apply

Over the counter sleeping medication, such as Unisom

Prescription sleeping medication, such as Ambien

Homeopathic sleep medication, such as melatonin

Anti-anxiety medication

Alcohol

Marijuana

Exercise and/or Yoga

Meditation

Visits to a sleep specialist

Hypnotism

CPAP Machine

Giving up or limiting caffeine

Giving up or limiting alcohol

Other (please specify)

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* 8. How do you cope the day after a bad night's sleep? Check two that most apply to you.

Find time for a proper nap

Go through the day grumpy

Hold out hope that the next night's sleep will be better

Drink lots of coffee/caffeine

Fall asleep in meetings or in other inappropriate places

Limit my driving for fear I could nod off

Take some type of medication to help me get through the day, either OTC or prescription

Cry a lot

Cancel activities for that night so I can go to sleep early

Eat lots of chocolate

Cancel any rigorous exercise

Exercise harder

Curse the sleep gods

Other (please specify)

Tell Us About Your Sleep

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* 1. How often do you have trouble sleeping?

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* 2. On average, how much sleep to you get per night?

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* 3. Are you sleeping better or worse than you were 10 years ago?

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* 4. What keeps you from sleeping well? Check all that apply.

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* 5. Which of the following best describes your main sleep issue?

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* 6. How much does your sleep issue impact the quality of your life?

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* 7. How do you treat your sleep problems? Check all that apply

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* 8. How do you cope the day after a bad night's sleep? Check two that most apply to you.

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* 9. What is your best advice for those dealing with insomnia?

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* 10. If you've visited a sleep specialist, what did you learn?

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* 11. How do you think menopause has contributed to your sleep issues?

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* 12. What questions would you like an expert to answer about sleep and insomnia?

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* 13. Your name

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* 14. Your email address please.