Sleep Screening Sleep Screening Number of minutes it usually takes you to fall asleep at night Less than 20 minutes Between 20 and 40 minutes Between 40 and 60 minutes Between 60 and 90 minutes More than 90 minutes Number of mintues you usually spend awake in the middle of the night Less than 20 minutes Between 20 and 40 minutes Between 40 and 60 minutes Between 60 and 90 minutes More than 90 minutes Number of minutes you usually wake up earlier than planned or hope for in the morning Less than 20 minutes Between 20 and 40 minutes Between 40 and 60 minutes Between 60 and 90 minutes More than 90 minutes How satisfied are you with your current sleep? Very satisfied Satisfied Somewhat satisfied Dissatisfied Very dissatisfied 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 A little Somewhat Much Very much How noticeable to others do you think your sleep problem is in terms of impairing the quality of your life? Not at all A little Somewhat Much Very much How worried or distressed are you about your current sleep problem? Not at all A little Somewhat Much Very much Based on © Morin, C.M. (1993). Insomnia: Psychological Assessment and Management. New York: Guilford Press. Schedule Your Initial Sleep Program Appointment
