To the best of your ability, please answer the questions below:

1 I look older than I am. (*)
2 I have trouble falling asleep at night. (*)
3 I wake up during the night. (*)
4 And I can't get back to sleep. (*)
5 My mind is busy with anxious thoughts while I am trying to fall asleep. (*)
6 My feet are too hot at night. (*)
7 When I get up, I don't feel rested. (*)
8 I feel like I'm living out of sync with the world: going to bed late and waking up late. (*)
9 I cannot tolerate jet lag. (*)
10 I smoke, drink, and/or use a beta blocker as a sleep aid. (*)
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