Don't try to get the answers "right". Answer the questions honestly.
Do you get drowsy after meals?
2. How long does it take you to fall
asleep at night?
3. On weekends, do you . . . ?
4. How many nights a week do you feel
you don't get enough sleep?
5. In the morning, you . . .
6. You get sleepy . . . (indicate all
answers which apply to you)
7. Do you snore?
8. What is your age?
9. You are getting off work and you are
worn out. What do you do?
10. Your drive home after work is . .
11. It's late Friday night and you're
leaving on vacation. Your destination is a 6 hour drive away. What do
12. When driving, you feel yourself getting
drowsy. You decide to stop for a bite to eat. What do you have?
13. You realize you are getting drowsy
and decide to turn on the radio to wake yourself up. What do you listen
14. What do you do to stay awake? (Circle
all which apply)
15. You are 2 hours into a 6 hour drive
and your eyes are feeling heavy. What do you do?