How long does it take for you to fall a sleep at night?

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* 1. How long does it take for you to fall a sleep at night?

If you wake up at night, what time is it usually and do you have difficulty going back to sleep?

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* 2. If you wake up at night, what time is it usually and do you have difficulty going back to sleep?

How do you feel when you wake up in the morning?

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* 3. How do you feel when you wake up in the morning?

How often do you have difficulty going to sleep?

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* 4. How often do you have difficulty going to sleep?

What is the average amount of sleep you have nightly?

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* 5. What is the average amount of sleep you have nightly?

Is part of your sleep problem do to physical pain?

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* 6. Is part of your sleep problem do to physical pain?

Are you often woken because of noise - snoring, animals, etc?

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* 7. Are you often woken because of noise - snoring, animals, etc?

How is a poor sleep or lack of sleep impacting your life?

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* 8. How is a poor sleep or lack of sleep impacting your life?

Would you like to make changes with your sleep habits?

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* 9. Would you like to make changes with your sleep habits?

Enter name and email below.

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* 10. Enter name and email below.

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