*Please enter 4 numbers you can remember for your unique ID. These can be your birthday or your telephone number. Use the same 4 numbers for all surveys. Only numbers may be entered in this field Choose 4 numbers you can remember that only you will know. Use the same numbers for all surveys. You can not use letters.

*PLease Enter your course number here.

*1. What time have you usually gone to bed during the past month? State a.m. or p.m. (Also indicate "noon" or "midnight") if your answer is 12:00.

*2. How many MINUTES has it taken you to fall asleep each night during the past month?

*3. At what time have you usually gotten up in the morning during the past month? Put a.m. or p.m. (i.e. 7:30 a.m.) (Also add "noon" or " midnight" if your answer is 12:00.)

*4. How many HOURS of actual sleep do you usually get on a typical night during the past month?

*5a. During the past month, how often have you had trouble sleeping because you cannot get to sleep within 30 minutes? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5b. During the past month, how often have you had trouble sleeping because you wake up in the middle of the night or early morning? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5c. During the past month, how often have you had trouble sleeping because you have to get up to use the bathroom? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5d. During the past month, how often have you had trouble sleeping because you cannot breath comfortably? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5e. During the past month, how often have you had trouble sleeping because you cough or snore loudly? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5f. During the past month, how often have you had trouble sleeping because you feel too cold? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5g. During the past month, how often have you had trouble sleeping because you feel too hot? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5h. During the past month, how often have you had trouble sleeping because you have bad dreams? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5i. During the past month, how often have you had trouble sleeping because you have pain? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*5j. During the past month, how often have you had trouble sleeping because of other reasons? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

If you had "other reason(s)" in the last question (5j), please describe this reason(s), including how often you have had trouble sleeping because of this reason(s).

*6. During the past month, how often have you taken medicine (prescribed or "over the counter") to help you sleep? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*7. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*8. During the past month, how much of a problem has it been for you to keep up your enthusiasm to get things done? Choose only one of the following Not during the past month (0) Less than once a week (1) Once or twice a week (2) 3 or more times a week (3)

*9. How would you rate your sleep quality overall? Choose only one of the following Very Good(0) Fairly Good (1) Fairly Bad (2) Very Bad (3)

PLease enter here any comments or clarifications you might have concerning the above questions.