Insomnia Type Questionnaire

This questionnaire concerns behavior and feelings that were shown to be important in sleep problems. The questionnaire contains a number of short questionnaires on different aspects of personality, sensitivities, behavior, mood, and sleep. All questions are multiple-choice. The alternatives differ depending on the questionnaire. Please read the instructions carefully and select the alternative that best reflects how you feel or see yourself most of the time. If you find this difficult, please choose the alternative that comes to mind first.

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A

The next questions concern your sleep over the last two weeks.

Please rate the current (i.e., last 2 weeks) severity of your insomnia problem(s).
None Mild Moderate Severe Very
Difficulty falling asleep:
Difficulty staying asleep:
Problem waking up too early:
How satisfied/dissatisfied are you with your current sleep pattern?
Very satisfied Somewhat satisfied Not satisfied, not dissatisfied Somewhat dissatisfied Very dissatisfied
To what extent do you consider your sleep problem to interfere with your daily functioning (e.g., daytime fatigue, ability to function at work/daily chores, concentration, memory, mood, etc.).
No interference at all A little Somewhat Moderate A lot of interference
How noticeable to others do you think your sleeping problem is in terms of impairing the quality of your life?
Not at all noticeable Barely Somewhat Much Very much noticeable
How worried/distressed are you about your current sleep problem?
Not at all A little Somewhat Much Very much

B

The next questions concern different aspects of your personality. Please select the alternative that best describes how you feel or see yourself most of the time.

  1. When I have lost something valuable and can’t find it anywhere:
  2. When I know I must finish something soon:
  3. When I’ve worked for weeks on one project and then everything goes completely wrong:
  4. When I don’t have anything in particular to do and I am getting bored:
  5. When I’m in a competition and lose every time:
  6. When I’m getting ready to tackle a difficult problem:
  7. If I had just bought a new piece of equipment (for example, a laptop) and it accidentally fell on the floor and was damaged beyond repair:
  8. When I have to solve a difficult problem:
  9. When I have to talk to someone about something important and, repeatedly, can’t find her/him at home:
  10. When I have to make up my mind about what I am going to do when I get some unexpected free time:
  11. When I’ve bought a lot of stuff at a store and realize when I get home that I paid too much – but I can’t get my money back:
  12. When I have work to do at home:
  13. When I am told that my work has been completely unsatisfactory:
  14. When I have a lot of important things to do:
  15. When I’m stuck in traffic and miss an important appointment:
  16. When there are two things that I really want to do, but I can’t do both of them:
  17. When something is very important to me, but I can’t seem to get it right:
  18. When I have to carry out an important but unpleasant task:
  19. When something really gets me down:
  20. When I am facing a big project that has to be done:
  21. When several things go wrong on the same day:
  22. When I have a boring assignment:
  23. When I have to put all my effort into doing a really good job on something and the whole thing doesn’t work out:
  24. When I have an obligation to do something that is boring and uninteresting:

C

The next questions concern different aspects of your personality. Please select the alternative that best describes how you feel or see yourself most of the time.

Very false for me Somewhat false for me Somewhat true for me Very true for me
I go out of my way to get things I want.
When I’m doing well at something I love to keep at it.
I’m always willing to try something new if I think it will be fun.
When I get something I want, I feel excited and energized.
When I want something I usually go all-out to get it.
I will often do things for no other reason than that they might be fun.
If I see a chance to get something I want I move on it right away.
When I see an opportunity for something I like I get excited right away.
I often act on the spur of the moment.
When good things happen to me, it affects me strongly.
I crave excitement and new sensations.
When I go after something I use a “no holds barred” approach.
It would excite me to win a contest.

D

The next questions concern happiness and satisfaction. Please select the alternative that best describes how you feel or see yourself most of the time.

Completely disagree Disagree Somewhat disagree Neutral Somewhat agree Agree Completely agree
In general, I consider myself a happy person.
Compared to most of my peers, I consider myself less happy.
Some people are generally very happy. They enjoy life regardless of what is going on, getting the most out of everything. To what extent does this characterization describe you?
Some people are generally not very happy. Although they are not depressed, they never seem as happy as they might be. To what extent does this characterization describe you?

E

The next questions concern happiness and satisfaction. Please select the alternative that best describes how often you think or do each of the following statements when you are feeling happy, excited, or enthused.

When you feel happy/satisfied, you...
Almost never Sometimes Often Almost always
notice how you feel full of energy.
savor this moment.
think “I am getting everything done”.
think about how you feel up to doing everything.
think “I am living up to my potential”.
think “This is too good to be true”.
think about how happy you feel.
think about how strong you feel.
think about things that could go wrong.
remind yourself these feelings won’t last.
think “People will think I’m bragging”.
think about how hard it is to concentrate.
think “I am achieving everything”.
think “I don’t deserve this”.
think “My streak of luck is going to end soon”.
think about how proud you are of yourself.
think about things that have not gone well for you.

F

The next questions concern how you feel or see yourself when you feel sad, blue, or depressed. Please select the alternative that best describes how often you think or do each of the following statements when you feel sad, blue, or depressed.

When you feel sad, blue or depressed, how often do you think or do each of the following statements?
Almost never Sometimes Often Almost always
Analyze recent events to try to understand why you are depressed.
Think “Why do I always react this way?”.
Go away by yourself and think about why you feel this way.
Write down what you are thinking and analyze it.
Think about a recent situation, wishing it had gone better.
Think “Why do I have problems other people don’t have”.
Think “Why can’t I handle things better?”.
Analyze your personality to try to understand why you are depressed.
Go someplace alone to think about your feelings.
Think “What am I doing to deserve this?”

G

The next questions concern your behavior. Please select the alternative that best describes yourself as you generally are now, not as you wish to be in the future. Describe yourself as honestly as you see yourself, in relation to other people you know of the same sex as you are, and roughly your same age.

I...
Very inaccurate Moderately inaccurate Neither accurate nor inaccurate Moderately accurate Very accurate
am the life of the party.
sympathize with others’ feelings.
have frequent mood swings.
don’t talk a lot.
am not interested in other people’s problems.
am relaxed most of the time.
talk to a lot of different people at parties.
feel others’ emotions.
get upset easily.
keep in the background.
am not really interested in others.
seldom feel blue.

H

The next questions concern different feelings and emotions. Please select the alternative that best describes to what extent you generally feel this way, that is, how you feel on average.

Very slightly or not at all A little Moderately Quite a bit Extremely
Attentive
Interested
Alert
Excited
Enthusiastic
Inspired
Proud
Determined
Strong
Active
Hostile
Irritable
Guilty
Ashamed
Nervous
Jittery
Upset
Distressed
Scared
Afraid

I

The next questions concern your experiences. Please read each statement carefully. Select the alternative that best describes how true that statement is for you in general.

Very false for me False Somewhat false Somewhat true True Very true for me
When I hear about a new movie starring my favorite actor, I can’t wait to see it.
I enjoy taking a deep breath of fresh air when I walk outside.
The smell of freshly cut grass is enjoyable to me.
I look forward to a lot of things in my life.
I love it when people play with my hair.
Looking forward to a pleasurable experience is in itself pleasurable.
A hot cup of coffee or tea on a cold morning is very satisfying to me.
When I think of something tasty, like chocolate chip cookie, I have to have one.
I appreciate the beauty of fresh snowfall.
I get so excited the night before a major holiday I can hardly sleep.
When I’m on my way to an amusement park, I can hardly wait to ride the roller coasters.
I really enjoy the feeling of a good yawn.
I don’t look forward to things like eating out at restaurants.
I love the sound of rain on the windows when I’m lying in my warm bed.
When I think about eating my favorite food, I can almost taste how good it is.
When ordering something off the menu, I imagine how good it will taste.
The sound of cracking wood in the fireplace is very relaxing.
When something exciting is coming up in my life, I really look forward to it.

J

The next questions concern traits and characteristics. Please select the alternative that best indicates how much you generally agree with each statement.

Strongly disagree Disagree Slightly disagree Neutral Slightly agree Agree Strongly agree
I am well-organized.
I’ve always felt pressure from my parent(s) to be the best.
If I do something less than perfectly, I have a hard time getting over it.
I think things should be put away in their place.
My parent(s) hold me to high standards.
I spend a lot of time worrying about things I’ve done, or things I need to do.
I would characterize myself as an orderly person.
My parent(s) are difficult to please.
If I make a mistake, my whole day is ruined.
I like to always be organized and disciplined.
My parent(s) have high expectations for achievement.
If I say or do something dumb I tend to think about it for the rest of the day.
I clean my home often.
Growing up, I felt a lot of pressure to do everything right.
When I make an error, I generally can’t stop thinking about it.
I make sure to put things away as soon as I’m done using them.
My parent(s) put a lot of pressure on me to succeed.
I often obsess over some of the things I have done.
My closet is neat and organized.
I always felt that my parent(s) wanted me to be perfect.
After I turn a project in, I can’t stop thinking of how it could have been better.
My workspace is generally organized.
My parent(s) have expected nothing but my best.

K

The next questions concern how stress can influence your sleep. When you experience the following situations, how likely is it for you to have difficulty sleeping? Please select an alternative even if you have not experienced these situations recently.

Not likely Somewhat likely Moderately likely Very likely
Before an important meeting the next day.
After a stressful experience during the day.
After a stressful experience in the evening.
After getting bad news during the day.
After watching a frightening movie or TV show.
After having a bad day at work.
After an argument.
Before having to speak in public.
Before going on vacation the next day.

L

The next questions concern your experiences as you attempt to fall asleep in your own bedroom. Please select the alternative that best describes how intensely you generally feel each of the symptoms as you attempt to fall asleep in your own bedroom.

Not at all Slightly Moderately A lot Extremely
Heart racing, pounding or beating irregularly.
A jittery, nervous feeling in your body.
Shortness of breath or labored breathing.
A tight, tense feeling in your muscles.
Cold feeling in your hands, feet or your body in general.
Have stomach upset (knot or nervous feeling in stomach, heartburn, nausea, gas, etc.).
Perspiration in palms of your hands or other parts of your body.
Dry feeling in mouth or throat.
Worry about falling asleep.
Review or ponder events of the day.
Depressing or anxious thoughts.
Worry about problems other than sleep.
Being mentally alert, active.
Can’t shut off your thoughts.
Thoughts keep running through your head.
Being distracted by sounds, noise in the environment (e.g., ticking of clock, house noises, traffic).

M

The next questions concern fatigue. Please select the alternative that best reflects your level of agreement with each of the statements.

Strongly disagree Disagree Slightly disagree Neutral Slightly agree Agree Strongly agree
My motivation is lower when I am fatigued.
Exercise brings on my fatigued.
I am easily fatigued.
Fatigue interferes with my physical functioning.
Fatigue causes frequent problems for me.
My fatigue prevents sustained physical functioning.
Fatigue interferes with carrying out certain duties and responsibilities.
Fatigue is among my three most disabling symptoms.
Fatigue interferes with my work, family or social life.

N

The questions on the following screens are about your experiences during the time you were a child and teenager (up to 17 years old).
The questions may concern very personal and intense experiences that could evoke unpleasant memories. Nevertheless, we ask you to answer as honestly as possible to provide the most accurate profile. If you feel that these questions are too distressing for you and you would prefer not to answer them, you can skip them and click the "submit" button at the bottom.

When I grew up...
Never true Rarely true Sometimes true Often true Very often true
I didn’t have enough to eat.
I knew that there was someone to take care of me and protect me.
people in my family called me things like “stupid”, “lazy” or “ugly”.
my parents were too drunk or high to take care of the family.
there was someone in my family who helped me feel that I was important or special.
wore dirty clothes.
I felt loved.
I thought that my parents wished I had never born.
I got hit so hard by someone in my family that I had to see a doctor or go to the hospital.
people in my family hit me so hard that it left me with bruises or marks.
I was punished with a belt, a board, a cord, or some other hard object.
people in my family looked out for each other.
people in my family said hurtful or insulting things to me.
I believe that I was physically abused.
I got hit or beaten so badly that it was noticed by someone like a teacher, neighbor, or doctor.
I felt that someone in my family hated me.
people in my family felt close to each other.
someone tried to touch me in a sexual way, or tried to make me touch them.
someone threatened to hurt me or tell lies about me unless I did something sexual with them.
someone tried to make me do sexual things or watch sexual things.
someone molested me.
I believe that I was emotionally abused.
there was someone to take me to the doctor if I needed it.
I believe that I was sexually abused.
my family was a source of strength and support.