stress and sleeping pattern

	Not during the past month (0)	Less than once a week (1)	Once or twice a week (2)	Three or more times a week (3)
A. Cannot get to sleep within 30 minutes

B. Wake up in the middle of the night or early morning

C. Have to get up to use the bathroom

D. Cannot breathe comfortably

E. Cough or snore loudly

F. Feel too cold

G. Feel too hot

H. Have bad dreams

I. Have pain

J. Other reason (s), including how often you have had trouble sleeping because of this reason (s)

2. During the past month, how would you rate your sleep quality overall?

3. In the last month, how often have you been upset
because of something that happened unexpectedly?

4. In the last month, how often have you felt that you were unable
to control the important things in your life?

5. In the last month, how often have you felt nervous and “stressed”?

6. In the last month, how often have you felt confident about your ability
to handle your personal problems?

7. In the last month, how often have you felt that things
were going your way?

8. In the last month, how often have you found that you could not cope
with all the things that you had to do?

9. In the last month, how often have you been able
to control irritations in your life?

10. In the last month, how often have you felt that you were on top of things?