How often do you have trouble falling asleep? Almost never Occasionally Frequently Almost every night None How often do you wake up in the middle of the night and have trouble going back to sleep? Almost never Occasionally Frequently Almost every night None Do you experience night sweats? Almost never Occasionally Frequently Almost every night None Do you feel irritable or have mood swings? Almost never Occasionally Frequently Daily None Have you noticed changes in your menstrual cycle (e.g., irregular periods)? No Once a year More than 3 times a year Always None Do you experience hot flashes? Almost never Occasionally Frequently Daily None Do you feel more anxious or stressed than usual? Almost never Occasionally Frequently Daily None Do you wake up feeling unrefreshed, despite sleeping through the night? Almost never Occasionally Frequently Almost every morning None 1 out of 2 Name Email Phone Time's up
