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1. How many hours of sleep do you generally get on a weeknight?

a. less than 2 hours     b. 2-3 hours      c. 4-5 hours     d.  6-7 hours   e. 8-9 hours   f. more than 10 hours

2.  What is the primary reason for your loss of sleep?

a. homework     b. electronics     c. unable to fall asleep    d. other ___________

3. How much caffeine do you drink in the morning?

a. none     b. 1 cup   c.  2-3 cups   d. 4 or more cups

4. How much caffeine do you drink at night after 8pm?

a. none     b. 1 cup   c.  2-3 cups   d. 4 or more cups

5. Once you have fallen asleep, how many times do you wake up in the night?

a. none    b. once    c. twice    d. more than 3 times a night