Please indicate true or false or the following statements:

True False
1. I have trouble following asleep.
2. I wake up a number of times during the night.
3. I wake up earlier than I would like and have trouble falling back asleep.
4. I wake up terrified in the middle of the night, but I do not know why.
5. I fall asleep spontaneously during the day in response to high arousal, such as when I hear a funny joke.
6. I have been told that I snore loudly and stop breathing temporarily during sleep.
7. I walk or talk in my sleep.
8. I move excessively in my sleep.
9. I have hurt myself or my bed partner while I was sleeping.
10. I become very confused, afraid, and/or disoriented after sundown.
11. I cannot fall asleep until very late at night or cannot wake up in the morning.
12. I cannot stay awake early in the evening and I wake up before dawn.
13. I feel mild pain or a tingling sensation in my legs just before falling asleep.
14. I physically act out my dreams during the night.
15. I am often too anxious, depressed, or worried to fall asleep.