Read if necessary: During the past 30 days...
How often did you take any medication to help you fall asleep or stay asleep? Include both
prescribed and over-the-counter medications.
Read if necessary: Would you say never, some days, most days, or every day?

1 - Never
2 - Some days
3 - Most days
4 - Every day
7 - Refused
9 - Don't Know

Sample Adults 18+

1-4,RF,DK [goto next section]

Read if necessary: During the past 30 days...
How often did you take any medication to help you fall asleep or stay asleep? Include both
prescribed and over-the-counter medications.
Read if necessary: Would you say never, some days, most days, or every day?

1 - Never
2 - Some days
3 - Most days
4 - Every day
7 - Refused
9 - Don't Know

Sample Adults 18+

1-4,RF,DK [goto next section]