Not during the past month (0) | Less than once a week (1) | Once or twice a week (2) | Three or more times a week (3) | |
a) Cannot get to sleep within 30 minutes |
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b) Wake up in the middle of the night or early morning |
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c) Have to get up to use the bathroom |
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d) Cannot breathe comfortably |
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e) Cough or snore loudly |
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f) Feel too cold |
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g) Feel too hot |
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h) Have bad dreams |
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i) Have pain |
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j) Other reason(s), please describe, including how often you have trouble sleeping because of this reason(s): |
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