1. Difficulty falling asleep (initial insomnia)

2. Difficulty staying asleep (middle insomnia)

3. Problem waking up too early (terminal insomnia)

4. How satisfied/dissatisfied are you with your current sleep pattern?

5. How noticeable to others do you think your sleep problem is in terms of impairing the quality of your life?

6. How worried/distressed are you about your current sleep problem?

7. To what extent do you consider your sleep problem to interfere with your daily functioning (e.g., daytime fatigue, mood, ability to function at work/school, social life, leisure activities)?