No problem at all

Only a very slight problem

Somewhat of a problem

A very big problem

9. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done

No bed partner or

roommate

Partner/ roommate in other room

Partner in same room but not same bed

Partner in same bed

10. Do you have a bed partner or roommate

Not during the past month

Less than Once a week

Once or twice a week

Three or more times a week

If you have a roommate or bed partner, ask him/her how often in the past month you have had:

a. Loud snoring

b. Long pauses between breaths while asleep

c. Legs twitching or jerking while you sleep

d. Episodes of disorientation or confusion during sleep

e. Other restlessness while you sleep, please describe: