17 Research Dr., Amherst, MA 01002
6 Hatfield St., Northampton, MA 01060
When did your recent sleep difficulties begin?
Daytime Effects: After a poor night's sleep, which of the following do you experience the next day? (check all that apply)
Your Current Sleep-Wake Schedule: Please describe previous or most recent typical week; describe range when indicated; note weekday/weekend times, if different.
BEGINNING OF SLEEP PERIOD
MIDDLE OF THE NIGHT
Please remember to indicate weekend schedule if different from above