Insomnia Screener Quiz

Welcome to Cerebra’s Insomnia Screening Quiz.
Please answer the following questions to help us determine which of our company’s resources would be helpful to you.

Insomnia Screener Quiz

I have problems with falling asleep or staying asleep *

Yes
No

It takes me over 5 hours to fall asleep every night no matter what I try *

Yes
No

I currently do shift work *

Yes
No

I have restless feelings in my legs (or arms) in the evenings which prevent me from falling asleep. *

Yes
No

I consume ____number of alcoholic beverages per week? *

0-7
8-14
15-22
23+

I have been diagnosed with manic depression or bipolar mood disorder *

Yes
No

I am currently in a crisis *

Yes
No

I have a tendency to experience falls *

Yes
No

Are you over the age of 18? *

Yes
No

This program is only for use in those 18 years or older.

* Required fields

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