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	<title>SLEEP ALL NIGHT &#187; Ask the Doctor</title>
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	<link>http://www.masteryoursleep.com</link>
	<description>sleep problems and solutions</description>
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		<title>Sleep Diary</title>
		<link>http://www.masteryoursleep.com/sleep-diary/</link>
		<comments>http://www.masteryoursleep.com/sleep-diary/#comments</comments>
		<pubDate>Tue, 14 Jul 2009 01:16:41 +0000</pubDate>
		<dc:creator>Sleep Master</dc:creator>
				<category><![CDATA[Ask the Doctor]]></category>
		<category><![CDATA[Sleep Dairy]]></category>
		<category><![CDATA[awake]]></category>
		<category><![CDATA[awake during the day]]></category>
		<category><![CDATA[fell asleep]]></category>
		<category><![CDATA[go to bed]]></category>
		<category><![CDATA[sleep]]></category>
		<category><![CDATA[SLEEP DIARY]]></category>
		<category><![CDATA[wake up at night]]></category>

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		<description><![CDATA[TWO WEEK SLEEP DIARY INSTRUCTIONS                                     1 Write the date, day of the week, and type of day: Work, School, Day Off, or Vacation                             [...]]]></description>
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<col span="1" width="109"></col>
<col span="1" width="22"></col>
<col span="7" width="26"></col>
<col span="1" width="14"></col>
<col span="7" width="26"></col>
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<tbody>
<tr height="22">
<td style="text-align: center;" colspan="18" width="535" height="22">
<h2><span style="color: #0000ff;">TWO WEEK SLEEP DIARY INSTRUCTIONS</span></h2>
</td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17">1</td>
<td colspan="17">Write the date, day of the week, and type of day: Work, School, Day Off, or Vacation</td>
</tr>
<tr height="14">
<td height="14"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17">2</td>
<td colspan="12">Put the letter “C” in the box when you have coffee, cola or tea</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17">3</td>
<td colspan="15">Put “M” when you take any medicine</td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17">4</td>
<td colspan="7">Put a line (l) to show when you go to bed </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="15">
<td height="15"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17">5</td>
<td colspan="11">Shade the box that shows when you think you fell asleep</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="23">
<td height="23"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="18">
<td height="18">6</td>
<td colspan="11">Leave boxes unshaded to show when you wake up at night </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="18">
<td height="18"> </td>
<td> </td>
<td colspan="10">and when you are awake during the day.</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="23">
<td height="23">7</td>
<td colspan="13">On a Monday when I worked, I jogged on my lunch break at 1 PM</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="21">
<td height="21"> </td>
<td> </td>
<td colspan="10">had a glass of wine with dinner at 6 PM</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="21">
<td height="21"> </td>
<td> </td>
<td colspan="10">fell asleep watching TV from 7 to 8 PM</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td colspan="5">went to bed at 11PM</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td colspan="7">fell asleep around Midnight</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="18">
<td height="18"> </td>
<td> </td>
<td colspan="13">woke up and couldn’t get back to sleep at about 4 AM</td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="19">
<td height="19"> </td>
<td> </td>
<td colspan="9">went back to sleep from 5 to 7 AM</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="21">
<td height="21"> </td>
<td> </td>
<td colspan="12">had coffee and medicine at 7:00 in the morning</td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="21">
<td height="21"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="20">
<td height="20"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td> </td>
<td style="text-align: center;" colspan="7"><strong><span style="color: #0000ff;">Week 1</span></strong></td>
<td><strong><span style="color: #0000ff;"> </span></strong></td>
<td style="text-align: center;" colspan="7"><strong><span style="color: #0000ff;">Week 2</span></strong></td>
</tr>
<tr height="17">
<td height="17"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="18">
<td height="18"> </td>
<td> </td>
<td> </td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Mon</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Tue</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Wed</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Thu</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Fri</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Sat</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Sun</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;"> </span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Mon</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Tue</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Wed</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Thu</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Fri</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Sat</span></strong></td>
<td style="text-align: center;"><strong><span style="color: #0000ff;">Sun</span></strong></td>
</tr>
<tr height="18">
<td height="18"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">Today’s Date</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="21">
<td height="21"> </td>
<td style="text-align: center;" width="109">Day of the week</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td style="text-align: left;" height="17"> </td>
<td style="text-align: center;" width="109">Type of Day</td>
<td style="text-align: left;" width="22"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
<td style="text-align: left;"> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">Noon</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">1 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">2 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">3 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">4 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">5 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">6 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">7 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">8 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">9 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">10 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">11 PM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">Midnight</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">1 AM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">2 AM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">3 AM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">4 AM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">5 AM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109">6 AM</td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
<tr height="17">
<td height="17"> </td>
<td style="text-align: center;" width="109"><strong>7 AM</strong></td>
<td style="text-align: center;" width="22"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
<td style="text-align: center;"><strong> </strong></td>
</tr>
<tr height="17">
<td height="17"><strong> </strong></td>
<td style="text-align: center;" width="109"><strong>8 AM</strong></td>
<td width="22"><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
</tr>
<tr height="17">
<td height="17"><strong> </strong></td>
<td style="text-align: center;" width="109"><strong>9 AM</strong></td>
<td width="22"><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
</tr>
<tr height="17">
<td height="17"><strong> </strong></td>
<td style="text-align: center;" width="109"><strong>10 AM</strong></td>
<td width="22"><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
<td><strong> </strong></td>
</tr>
<tr height="17">
<td height="17"><strong> </strong></td>
<td style="text-align: center;" width="109"><strong>11 AM</strong></td>
<td width="22"> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
<td> </td>
</tr>
</tbody>
</table>
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		</item>
		<item>
		<title>Medication Log</title>
		<link>http://www.masteryoursleep.com/medication-log/</link>
		<comments>http://www.masteryoursleep.com/medication-log/#comments</comments>
		<pubDate>Mon, 22 Jun 2009 15:46:29 +0000</pubDate>
		<dc:creator>Sleep Master</dc:creator>
				<category><![CDATA[Ask the Doctor]]></category>
		<category><![CDATA[Medication Log]]></category>
		<category><![CDATA[Asleep medicines]]></category>
		<category><![CDATA[behavioral healthcare]]></category>
		<category><![CDATA[dosage]]></category>
		<category><![CDATA[drug allergies]]></category>
		<category><![CDATA[family doctor]]></category>
		<category><![CDATA[healthcare]]></category>
		<category><![CDATA[medication information]]></category>
		<category><![CDATA[over-the-counter]]></category>
		<category><![CDATA[pharmacist]]></category>
		<category><![CDATA[prescription sleep medications]]></category>
		<category><![CDATA[primary care physician]]></category>
		<category><![CDATA[problems with medication]]></category>
		<category><![CDATA[Side effects]]></category>
		<category><![CDATA[sleep doctor]]></category>

		<guid isPermaLink="false">http://www.masteryoursleep.com/?p=1055</guid>
		<description><![CDATA[About Your Medications * Keep a list of all medications and supplements you take. * Tell your primary care physician (family doctor), behavioral healthcare professional, sleep doctor, and/or pharmacist about all the medicines you take including any over-the-counter medicines, as well as any drug allergies that you may have. * Ask your pharmacist about side effects and [...]]]></description>
			<content:encoded><![CDATA[<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-style: italic;"><span style="color: #0000ff;">About Your Medications</span></span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #000000;">* Keep a list of all medications and supplements you take.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #000000;">* Tell your primary care physician (family doctor), behavioral healthcare professional, sleep doctor, and/or pharmacist about all the medicines you take including any over-the-counter medicines, as well as any drug allergies that you may have.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #000000;">* Ask your pharmacist about side effects and what foods or liquids to avoid while taking medications.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;">* Read the label, including warnings. Make sure that you receive the medication that was prescribed for you and </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;">you know how to use it.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #000000;">* If the medication looks different than you expected, ask the pharmacist about it.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #0000ff;">Medication Information Log</span></span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">* <span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">Use this log to record the medications that you are taking. If you have any concerns about them, then ask your doctor.</span></span></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;"><span style="color: #000000;">* </span>Bring this log with you when you go to the doctor.</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"> </p>
<p class="MsoNormal" style="TEXT-ALIGN: center; LINE-HEIGHT: normal; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"> </span></p>
<table class="MsoTableGrid" style="border-collapse: collapse; mso-border-alt: double #984806 1.5pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt double #984806; mso-border-insidev: 1.5pt double #984806; mso-border-insideh-themecolor: accent6; mso-border-insideh-themeshade: 128; mso-border-insidev-themecolor: accent6; mso-border-insidev-themeshade: 128;" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes;">
<td style="padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; border: #984806 1.5pt double;" width="169">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;">DESCRIPTION</span></strong></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; background: #d9d9d9; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128;" width="96">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #0000ff;"><strong>Medication #1</strong></span></span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; background: #d9d9d9; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128;" width="90">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #0000ff;"><strong>Medication #2</strong></span></span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; background: #d9d9d9; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128;" width="90">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #0000ff;"><strong>Medication #N</strong></span></span></p>
</td>
</tr>
<tr style="height: 27.4pt; mso-yfti-irow: 1;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Medication Name</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">and Dosage</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 25.6pt; mso-yfti-irow: 2;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Name of the doctor who</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Prescribed the medication</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 27.4pt; mso-yfti-irow: 3;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Date on the medication</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">bottle</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 27.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 30.1pt; mso-yfti-irow: 4;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 30.1pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Are you still taking this</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">medicine?</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 30.1pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Yes ( )</span></span></p>
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">No ( )</span></span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 30.1pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Yes ( )</span></span></p>
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">No ( )</span></span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 30.1pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Yes ( )</span></span></p>
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">No ( )</span></span></p>
</td>
</tr>
<tr style="height: 40.9pt; mso-yfti-irow: 5;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Are you having any</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Trouble with this</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">medicine?</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Yes ( )</span></span></p>
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">No ( )</span></span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Yes ( )</span></span></p>
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">No ( )</span></span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Yes ( )</span></span></p>
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">No ( )</span></span></p>
</td>
</tr>
<tr style="height: 25.6pt; mso-yfti-irow: 6;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">How many pills do you</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">take at one time?</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 40.9pt; mso-yfti-irow: 7;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">How many times a day</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">do you take your</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">medicine?</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 40.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 25.6pt; mso-yfti-irow: 8; mso-yfti-lastrow: yes;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; padding-left: 5.4pt; width: 126.9pt; padding-right: 5.4pt; background: #d9d9d9; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128;" width="169">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">Problems with the</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial,Bold&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-family: 'Arial,Bold'; mso-bidi-font-weight: bold;">medication</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 1in; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="96" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 25.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
</tbody>
</table>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #000081; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
<table class="MsoTableGrid" style="border-collapse: collapse; mso-border-alt: double #984806 1.5pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt double #984806; mso-border-insidev: 1.5pt double #984806; mso-border-insideh-themecolor: accent6; mso-border-insideh-themeshade: 128; mso-border-insidev-themecolor: accent6; mso-border-insidev-themeshade: 128;" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="height: 36.75pt; mso-yfti-irow: 0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes;">
<td style="padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 335.15pt; padding-right: 5.4pt; height: 36.75pt; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; border: #984806 1.5pt double;" width="447" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #0000ff;"><strong>List below any questions you might have for your doctor:</strong></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">1. ____________________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">2. ____________________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">3. ____________________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">4. ____________________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Allergies_______________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 10pt;"><span style="color: #000000;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">______________________________________________________________</span><span class="mw-headline"><strong> </strong></span></span></p>
</td>
</tr>
</tbody>
</table>
<p class="MsoNormal" style="margin: 0in 0in 10pt;"><span class="mw-headline"><strong><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #0070c0; font-size: 10pt;" lang="EN-CA"> </span></strong></span></p>
<p class="MsoNormal" style="text-align: left; margin: 0in 0in 10pt;"><span class="mw-headline"><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt;" lang="EN-CA"><span style="color: #0000ff;"><strong>Personal Information:</strong></span></span></span></p>
<table class="MsoTableGrid" style="border-collapse: collapse; mso-border-alt: double #984806 1.5pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt double #984806; mso-border-insidev: 1.5pt double #984806; mso-border-insideh-themecolor: accent6; mso-border-insideh-themeshade: 128; mso-border-insidev-themecolor: accent6; mso-border-insidev-themeshade: 128;" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="height: 30.75pt; mso-yfti-irow: 0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes;">
<td style="padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 354.7pt; padding-right: 5.4pt; height: 30.75pt; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; border: #984806 1.5pt double;" width="473" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Your Name<span style="mso-spacerun: yes;">    </span>__________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Address<span style="mso-spacerun: yes;">        </span><span style="mso-spacerun: yes;"> </span>__________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Phone Number ________________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Primary Care Physician Name_____________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Physician&#8217;s Address_____________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Physician&#8217;s Phone Number________________________________________</span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 12pt 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;"><span style="color: #000000;">Emergency Contact _____________________________________________</span></span></p>
<p class="MsoNormal" style="margin: 12pt 0in 10pt;"><span style="color: #000000;"><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US; mso-bidi-font-weight: bold;">_____________________________________________________________</span></span></p>
</td>
</tr>
</tbody>
</table>
<p class="MsoNormal" style="margin: 0in 0in 10pt;"><span class="mw-headline"><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt;" lang="EN-CA"> </span></span></p>
<script type="text/javascript" class="owbutton" src="http://onlywire.com/button" title="Medication Log" url="http://www.masteryoursleep.com/medication-log/ "></script>]]></content:encoded>
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		</item>
		<item>
		<title>Bed Partner Questionnaire</title>
		<link>http://www.masteryoursleep.com/bed-partner-questionnaire/</link>
		<comments>http://www.masteryoursleep.com/bed-partner-questionnaire/#comments</comments>
		<pubDate>Sun, 21 Jun 2009 21:20:23 +0000</pubDate>
		<dc:creator>Sleep Master</dc:creator>
				<category><![CDATA[Ask the Doctor]]></category>
		<category><![CDATA[Bed Partner Questionnaire]]></category>
		<category><![CDATA[bad nights of sleep]]></category>
		<category><![CDATA[nights of sleep]]></category>
		<category><![CDATA[over-the-counter medications]]></category>
		<category><![CDATA[Questionnaire]]></category>
		<category><![CDATA[SLEEP DIARY]]></category>
		<category><![CDATA[sleep doctor]]></category>
		<category><![CDATA[sleep problem]]></category>
		<category><![CDATA[sleep-related]]></category>
		<category><![CDATA[your sleep]]></category>

		<guid isPermaLink="false">http://www.masteryoursleep.com/?p=1041</guid>
		<description><![CDATA[Before Visiting Sleep Doctor  It is recommended to ask your bed partner to accompany you to the appointment. Another person who lives with you or visits frequently may finish the questionnaire, if you don’t have a regular bed partner.   * Make sure he or she completes the Bed Partner Questionnaire for you and brings [...]]]></description>
			<content:encoded><![CDATA[<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"><a href="http://www.masteryoursleep.com/wp-content/uploads/2009/06/bedpartnerqa-p2.gif"></a></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="color: #0000ff;"><strong>Before Visiting Sleep Doctor</strong> </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"><a href="http://www.masteryoursleep.com/wp-content/uploads/2009/06/bedpartnerqa-p12.jpg"></a>It is recommended to ask your bed partner to accompany you to the appointment. Another person who lives with you or visits frequently may finish the questionnaire, if you don’t have a regular bed partner. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"> </p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Make sure he or she completes the </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;"><a href="http://www.masteryoursleep.com/wp-content/uploads/2009/06/bedpartner-qa.xls">Bed Partner Questionnaire</a></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"><a href="http://www.masteryoursleep.com/wp-content/uploads/2009/06/bedpartner-qa.xls"> </a>for you and brings it to your appointment if it won’t be possible for your partner to attend. In fact, the sleep doctor may talk to your bed partner at another time. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Do not forget to bring with you all medications you are presently taking, because most people can’t recall details of prescriptions or over-the-counter medications. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Complete the </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;"><a href="http://www.masteryoursleep.com/?p=1055" target="_self">Medication Log </a></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">and bring it to the appointment. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">In addition, you maybe asked to fill other medical forms and sleep-related questionnaires. Also, the sleep center or the doctor may ask you to keep notes of events, called a &#8220;<a href="http://www.masteryoursleep.com/ask-the-doctor/sleep-diary/">sleep diary</a>,&#8221; Those notes will display psychological and social issues and your own thoughts and feeling regarding your sleep problem. This diary may be very important for your doctor. </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: RU;" lang="RU">It</span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> will enable you to reconstruct specific bad nights of sleep, as well as the events of the day before. The sleep diary could help you in understanding particular events, which affected your sleep.</span></p>
<p><a href="http://www.masteryoursleep.com/wp-content//2009/06/bedpartnerqa-p11.jpg"></a><a href="http://www.masteryoursleep.com/wp-content//2009/06/bedpartnerqa-p3.jpg"></a><a href="http://www.masteryoursleep.com/wp-content//2009/06/bedpartnerqa-p1.jpg"></a></p>
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		<title>Ask the Doctor</title>
		<link>http://www.masteryoursleep.com/ask-the-doctor/</link>
		<comments>http://www.masteryoursleep.com/ask-the-doctor/#comments</comments>
		<pubDate>Sat, 20 Jun 2009 20:21:56 +0000</pubDate>
		<dc:creator>Sleep Master</dc:creator>
				<category><![CDATA[Ask the Doctor]]></category>
		<category><![CDATA[American Academy of Sleep Medicine]]></category>
		<category><![CDATA[Canadian Sleep Society]]></category>
		<category><![CDATA[health care providers]]></category>
		<category><![CDATA[licensed medical doctor]]></category>
		<category><![CDATA[personal relationship]]></category>
		<category><![CDATA[procedures]]></category>
		<category><![CDATA[Qualifying the Healthcare Provider]]></category>
		<category><![CDATA[sleep center]]></category>
		<category><![CDATA[sleep facility]]></category>
		<category><![CDATA[sleep in separate beds]]></category>
		<category><![CDATA[sleep medicine]]></category>
		<category><![CDATA[sleep specialist]]></category>
		<category><![CDATA[sleep-related difficulties]]></category>
		<category><![CDATA[Sleeping pills]]></category>
		<category><![CDATA[treatments]]></category>
		<category><![CDATA[unable to stay asleep]]></category>
		<category><![CDATA[unable to stay awake]]></category>
		<category><![CDATA[your sleep]]></category>

		<guid isPermaLink="false">http://www.masteryoursleep.com/?p=1037</guid>
		<description><![CDATA[Qualifying the Healthcare Provider Are you licensed medical doctor? Do you have any professional accreditation from your Association?  If you are in the search for a sleep specialist or sleep center, it is important to ask about their medical status as health care providers. It is quite common that not all licensed sleep specialists practice [...]]]></description>
			<content:encoded><![CDATA[<h2 class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Qualifying the Healthcare Provider</span></h2>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Are you licensed medical doctor?</span></strong><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-themecolor: accent1; mso-themeshade: 128; mso-ansi-language: EN-US;"><span style="color: #0000ff;">Do you have any professional accreditation from your Association?</span></span></strong><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></strong></p>
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<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong> </strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">If you are in the search for a sleep specialist or sleep center, it is important to ask about their medical status as health care providers. </span></div>
</li>
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<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">It is quite common that not all licensed sleep specialists practice at a licensed sleep center and likewise. </span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">From another hand, not all licensed sleep centers employ licensed sleep doctors. </span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">With the reference to </span><span lang="EN-CA"><a href="http://en.wikipedia.org/wiki/American_Academy_of_Sleep_Medicine"><em><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;" lang="EN-US"><span style="color: #0000ff;">American Academy of Sleep Medicine</span></span></em></a></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> (AASM) we can be assured that accreditation means that the sleep facility meets the highest standards for being knowledgeable in the field of sleep medicine, procedures, and treatments. In this case you as a patient will expect some degree of confidence and protection. </span></div>
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<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">The same conditions are applied to </span><span lang="EN-CA"><a href="http://www.css.to/"><em style="mso-bidi-font-style: normal;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;" lang="EN-US"><span style="color: #0000ff;">Canadian Sleep Society</span></span></em></a></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> (CSS), which is <em style="mso-bidi-font-style: normal;">a </em></span><em style="mso-bidi-font-style: normal;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt;" lang="EN-CA">professional association of clinicians, scientists and technologists formed in June 1986 to further the advancement and understanding of sleep and its disorders through scientific study and public awareness. </span></em></div>
</li>
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<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><em style="mso-bidi-font-style: normal;"></em><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt;" lang="EN-CA">Please refer to </span><span lang="EN-CA"><em style="mso-bidi-font-style: normal;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt;"><span style="color: #0000ff;"><a href="http://www.masteryoursleep.com/sleep-disorders-treatment/sleep-disorder-centers/">Sleep Centers</a></span></span></em></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt;" lang="EN-CA"><a href="http://www.masteryoursleep.com/sleep-disorders-treatment/sleep-disorder-centers/"> </a>section of this Web site for more actual location, directions, and phone numbers.</span><em style="mso-bidi-font-style: normal;"></em></p>
</li>
</ul>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">How long have you been practicing sleep medicine?</span></strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
<ul>
<li>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">If you are in the sleep center, this question could be modified to the following: </span><em><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">&#8220;How long has this sleep center been diagnosing and treating sleep disorder patients?&#8221;</span></em><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</li>
<li>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">If there is a sleep specialist, ask him/her the following question:</span><em><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">&#8220;<span style="color: #0000ff;">How many years have you been practicing sleep medicine?&#8221;</span></span></em><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</li>
</ul>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Before making an appointment and after you decided about the sleep center where you are planning to see a sleep specialist, <strong style="mso-bidi-font-weight: normal;">you need to check yourself</strong> if you experience (presently or in the past) the following conditions that may indicate that professional consultation is needed:</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 9pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Your sleep-related difficulties persisted for over a month </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 9pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* You have noticed that one or more conditions, such as: often unable to fall asleep, unable to stay asleep all night, or unable to stay awake during the day</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 9pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Due to your sleep problem you happened to run into a car accident, lost employment, or destroyed personal relationship</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 9pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Your sleeping pills make you addicted</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 9pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* You are trying to sleep in separate beds to stay away from your partner because of your snoring and/or your restless legs behavior</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 9pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* You realized that after trying everything you know, you still have problems with your sleep. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Another sign that you must see a sleep doctor is when your night time sleep pattern reflects your daytime performance</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Your family physician will be able to determine the cause of your sleep problems and can refer you to a reputable, licensed sleep specialist or a sleep center in your area.</span></p>
<p class="MsoNormal" style="margin: 0in 0in 10pt;"><strong><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Watch Video: Ask the Doctor</span></strong></p>
<p style="text-align: center;"><object classid="clsid:d27cdb6e-ae6d-11cf-96b8-444553540000" width="425" height="344" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0"><param name="allowFullScreen" value="true" /><param name="allowscriptaccess" value="always" /><param name="src" value="http://www.youtube.com/v/R3iKWxm6mh8&amp;hl=en&amp;fs=1&amp;" /><param name="allowfullscreen" value="true" /><embed type="application/x-shockwave-flash" width="425" height="344" src="http://www.youtube.com/v/R3iKWxm6mh8&amp;hl=en&amp;fs=1&amp;" allowfullscreen="true" allowscriptaccess="always"></embed></object>
</p>
<p class="MsoNormal" style="margin: 0in 0in 10pt;"><strong><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Just before Your Scheduled Appointment</span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Most sleep centers perform many similar procedures. Usually, you can ask the receptionist of the center to mail you their forms and other required questionnaires before your appointment. It is advisable that you also complete the </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;"><strong><span style="color: #0000ff;">Sleep Log</span></strong></span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">:</span></p>
<table class="MsoTableGrid" style="margin: auto auto auto 27.9pt; border-collapse: collapse; background: #d9d9d9; mso-background-themecolor: background1; mso-background-themeshade: 217; mso-border-alt: double #984806 1.5pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: none; mso-border-insidev: none;" border="1" cellspacing="0" cellpadding="0">
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<td style="padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 14.25pt; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; border: #984806 1.5pt double;" width="162">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">SLEEP LOG</span></strong></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; height: 14.25pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-left-alt: double #984806 1.5pt;" width="42">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Mon</span></strong></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; height: 14.25pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-left-alt: double #984806 1.5pt;" width="38">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Tue</span></strong></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; height: 14.25pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-left-alt: double #984806 1.5pt;" width="43">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Wed</span></strong></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; height: 14.25pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-left-alt: double #984806 1.5pt;" width="39">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Thu</span></strong></p>
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<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Fri</span></strong></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; height: 14.25pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-left-alt: double #984806 1.5pt;" width="35">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Sat</span></strong></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; height: 14.25pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-left-alt: double #984806 1.5pt;" width="40">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Sun</span></strong></p>
</td>
</tr>
<tr style="height: 30.9pt; mso-yfti-irow: 1;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: double 1.5pt; mso-border-bottom-alt: solid .75pt; mso-border-right-alt: solid .75pt; mso-border-color-alt: #984806;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">When you trying to sleep, did you turn off the lights?</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 30.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: double 1.5pt; mso-border-bottom-alt: solid .75pt; mso-background-themecolor: background1; mso-border-right-alt: double 1.5pt; mso-border-color-alt: #984806;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 34.35pt; mso-yfti-irow: 2;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">When was the last time you wake up this morning?</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 34.35pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 36.6pt; mso-yfti-irow: 3;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Did you take naps yesterday? <strong>If yes,</strong> give total length of sleep in minutes.</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 36.6pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 20.25pt; mso-yfti-irow: 4;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">How many minutes did it take you to fall asleep last night?</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 20.25pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 24.9pt; mso-yfti-irow: 5;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">How many hours did you actually sleep last night?</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 24.9pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 31.5pt; mso-yfti-irow: 6;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">How many minutes were you awake during the night? Do not count the time it took you to fall asleep initially. </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 31.5pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 22.5pt; mso-yfti-irow: 7;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Compared with your own average over the last month, how well did you sleep last night</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 22.5pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 33pt; mso-yfti-irow: 8;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">How often did you wake up last night?</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 33pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 50.1pt; mso-yfti-irow: 9;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">How refreshing and restorative was your sleep? Was it better or worse than your average?</span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 50.1pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
</tr>
<tr style="height: 33.75pt; mso-yfti-irow: 10;">
<td style="border-bottom: #984806 1pt solid; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Did you take any sleeping medication? Record time and amount. </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1pt solid; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 33.75pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1; mso-border-right-alt: double #984806 1.5pt;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
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<tr style="height: 34.5pt; mso-yfti-irow: 11; mso-yfti-lastrow: yes;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 121.5pt; padding-right: 5.4pt; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: double 1.5pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid .75pt; mso-border-bottom-alt: double 1.5pt; mso-border-right-alt: solid .75pt; mso-border-color-alt: #984806;" width="162">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">When did you get out of bed for the last time this morning</span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.35pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-border-bottom-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="42" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 28.6pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-border-bottom-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="38" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 31.95pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-border-bottom-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="43" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.15pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-border-bottom-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="39" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 27.45pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-border-bottom-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="37" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 26.4pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1pt solid; padding-top: 0in; mso-border-alt: solid #984806 .75pt; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-border-bottom-alt: double #984806 1.5pt; mso-background-themecolor: background1;" width="35" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; padding-left: 5.4pt; width: 29.7pt; padding-right: 5.4pt; background: white; height: 34.5pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-left-alt: solid #984806 .75pt; mso-border-right-themeshade: 128; mso-border-top-alt: solid #984806 .75pt; mso-background-themecolor: background1;" width="40" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
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</tbody>
</table>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #0000ff;"><strong>Bed Partner</strong></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">It is recommended to ask your bed partner to accompany you to the appointment. Another person who lives with you or visits frequently may finish the questionnaire, if you don’t have a regular bed partner. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Make sure he or she completes the </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Bed Partner Questionnaire</span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> for you and bring to your appointment if it won’t be possible for your partner to attend. In fact, the sleep doctor may talk to your bed partner at another time. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Do not forget to bring with you all medications you are presently taking, because most people can’t recall details of prescriptions or over-the-counter medications. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; padding-left: 30px; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">* Complete the </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Medication Log </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">and bring it to the appointment. </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; font-size: 10pt; mso-ansi-language: EN-US;"><span style="color: #0000ff;"><strong>Sleep Diary</strong></span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">In addition, you maybe asked to fill other medical forms and sleep-related questionnaires. Also, the sleep center or the doctor may ask you to keep notes of events, called a &#8220;sleep diary,&#8221; Those notes will display psychological and social issues and your own thoughts and feeling regarding your sleep problem. This diary may be very important for your doctor. </span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: RU;" lang="RU">It</span><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> will enable you to reconstruct specific bad nights of sleep, as well as the events of the day before. The sleep diary could help you in understanding particular events, which affect your sleep.</span></p>
<p class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">For more information please click <a href="www.asksleepdoctor.com/start.asp" target="_self"><em>here</em></a></span><span style="line-height: 115%; font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">:</span><span class="mw-headline"><strong style="mso-bidi-font-weight: normal;"></strong></span></p>
<script type="text/javascript" class="owbutton" src="http://onlywire.com/button" title="Ask the Doctor" url="http://www.masteryoursleep.com/ask-the-doctor/ "></script>]]></content:encoded>
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		<item>
		<title>Questionnaire</title>
		<link>http://www.masteryoursleep.com/questionnaire/</link>
		<comments>http://www.masteryoursleep.com/questionnaire/#comments</comments>
		<pubDate>Fri, 19 Jun 2009 19:15:16 +0000</pubDate>
		<dc:creator>Sleep Master</dc:creator>
				<category><![CDATA[Ask the Doctor]]></category>
		<category><![CDATA[Questionnaire]]></category>
		<category><![CDATA[choking]]></category>
		<category><![CDATA[disrupted sleep]]></category>
		<category><![CDATA[doze]]></category>
		<category><![CDATA[dozing]]></category>
		<category><![CDATA[gasping]]></category>
		<category><![CDATA[legs kick]]></category>
		<category><![CDATA[sleep]]></category>
		<category><![CDATA[Sleep Deprivation]]></category>
		<category><![CDATA[sleep disorders]]></category>
		<category><![CDATA[sleep dysfunction]]></category>
		<category><![CDATA[sleep questionnair]]></category>
		<category><![CDATA[sleepy]]></category>
		<category><![CDATA[somnolence]]></category>

		<guid isPermaLink="false">http://www.masteryoursleep.com/?p=1025</guid>
		<description><![CDATA[Sleep dysfunction, prior to be identified as sleep disorder, can manifest in several ways, ranging from insomnia to somnolence, and from disrupted sleep to sleep deprivation. Measuring sleep dysfunction is ongoing research; and there is a number of patient-reported outcome methods and procedures that measure various aspects of sleep dysfunction. Before going to sleep practitioner [...]]]></description>
			<content:encoded><![CDATA[<p class="MsoNormal" style="LINE-HEIGHT: normal; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none"><span style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt; mso-ansi-language: EN-US">Sleep <a href="http://www.merriam-webster.com/dictionary/dysfunction" target="_self"><em><span style="color: #0000ff;">dysfunction</span></em></a>, prior to be identified as sleep disorder, can manifest in several ways, ranging from insomnia to <em><a href="http://en.wikipedia.org/wiki/Somnolence" target="_self"><span style="color: #0000ff;">somnolence</span></a></em>, and from disrupted sleep to <em><a href="http://en.wikipedia.org/wiki/Sleep_Deprivation" target="_self"><span style="color: #0000ff;">sleep deprivation</span></a></em>. Measuring sleep dysfunction is ongoing research; and there is a number of patient-reported outcome methods and procedures that measure various aspects of sleep dysfunction. </span></p>
<p class="MsoNormal" style="LINE-HEIGHT: normal; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none"><span style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt; mso-ansi-language: EN-US">Before going to sleep practitioner you need to make certain preparation, one of them being a questionnaire you take with you. An example of this questionnaire, as well as additional links are shown on the bottom of this page:</span></p>
<table class="MsoTableGrid" style="margin: auto auto auto 5.4pt; border-collapse: collapse; background: #ddd9c3; mso-border-alt: double #984806 1.5pt; mso-border-themecolor: accent6; mso-yfti-tbllook: 1184; mso-padding-alt: 0in 5.4pt 0in 5.4pt; mso-border-insideh: 1.5pt double #984806; mso-border-insidev: 1.5pt double #984806; mso-border-themeshade: 128; mso-background-themecolor: background2; mso-background-themeshade: 230; mso-border-insideh-themecolor: accent6; mso-border-insideh-themeshade: 128; mso-border-insidev-themecolor: accent6; mso-border-insidev-themeshade: 128;" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="height: 12.1pt; mso-yfti-irow: 0; mso-yfti-firstrow: yes;">
<td style="padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 63pt; padding-right: 5.4pt; height: 12.1pt; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; border: #984806 1.5pt double;" rowspan="2" width="84">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Please complete and return to your physician</span></strong></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 243pt; padding-right: 5.4pt; height: 12.1pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themeshade: 128;" rowspan="2" width="324">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Name: _________________________<span style="mso-spacerun: yes;">                     </span></span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Date: <span style="mso-spacerun: yes;">  </span>_________________________</span></strong></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 12.1pt; border-top: #984806 1.5pt double; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-themeshade: 128; mso-border-left-themeshade: 128;" width="90" valign="top">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Chance of dozing</span></strong></p>
</td>
</tr>
<tr style="height: 28.85pt; mso-yfti-irow: 1;">
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; height: 28.85pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">0 = never </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">1 = slight </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">2 = moderate </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">3 = high </span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 2;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 63pt; padding-right: 5.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="84">
<p class="MsoNormal" style="text-align: center; line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;" align="center"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: blue; font-size: 10pt; mso-ansi-language: EN-US;">Situation</span></strong></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 243pt; padding-right: 5.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="324" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Sitting and reading</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Watching TV</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Sitting, inactive in a public place </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Passenger in a car without a break</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Lying down to rest when circumstances permit</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Sitting and talking to someone</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Sitting quietly after lunch, without alcohol</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">In a car, while stopped for a few minutes in traffic</span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">   </span><span style="mso-spacerun: yes;"> </span>1<span style="mso-spacerun: yes;">   </span><span style="mso-spacerun: yes;"> </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;">  </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt -5.4pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"><span style="mso-spacerun: yes;">   </span>0<span style="mso-spacerun: yes;">    </span>1<span style="mso-spacerun: yes;">    </span>2<span style="mso-spacerun: yes;">    </span>3</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Total: <span style="mso-spacerun: yes;"> </span>_____</span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">
<td style="border-bottom: #984806 1.5pt double; border-left: #984806 1.5pt double; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 63pt; padding-right: 5.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-themecolor: accent6; mso-border-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="84" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><strong><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: #0070c0; font-size: 9pt; mso-ansi-language: EN-US;">How likely are you to doze off or fall asleep in the following situations?</span></strong></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 243pt; padding-right: 5.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="324" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Do you often feel sleepy during the daytime?</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Do you snore, or anyone told you that you snore?<span style="mso-spacerun: yes;">              </span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Do you know that you stop breathing during sleep? <strong><span style="mso-spacerun: yes;">    </span></strong></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Did you feel choking or gasping sensation during sleep?<span style="mso-spacerun: yes;">   </span></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Do your legs &#8216;kick&#8217; during sleep?<span style="mso-spacerun: yes;">    </span><strong><span style="mso-spacerun: yes;">                                    </span><span style="mso-spacerun: yes;">        </span></strong></span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;"> </span></p>
</td>
<td style="border-bottom: #984806 1.5pt double; border-left: #ece9d8; padding-bottom: 0in; background-color: transparent; padding-left: 5.4pt; width: 67.5pt; padding-right: 5.4pt; border-top: #ece9d8; border-right: #984806 1.5pt double; padding-top: 0in; mso-border-left-alt: double #984806 1.5pt; mso-border-left-themecolor: accent6; mso-border-left-themeshade: 128; mso-border-top-themecolor: accent6; mso-border-top-themeshade: 128; mso-border-bottom-themecolor: accent6; mso-border-bottom-themeshade: 128; mso-border-right-themecolor: accent6; mso-border-right-themeshade: 128; mso-border-top-alt: double #984806 1.5pt;" width="90" valign="top">
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 0.05in; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Yes<span style="mso-spacerun: yes;">       </span>No</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 0.05in; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Yes<span style="mso-spacerun: yes;">       </span>No</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 0.05in; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Yes<span style="mso-spacerun: yes;">       </span>No</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 0.05in; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Yes<span style="mso-spacerun: yes;">       </span>No</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt 0.05in; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 9pt; mso-ansi-language: EN-US;">Yes<span style="mso-spacerun: yes;">       </span>No</span></p>
</td>
</tr>
</tbody>
</table>
<p class="MsoNormal" style="LINE-HEIGHT: normal; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none"> </p>
<p class="MsoNormal" style="LINE-HEIGHT: normal; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none"><span style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt; mso-ansi-language: EN-US"> </span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">Indicate you present knowledge of Sleep Disorders (beginner/average/advanced): _____</span></p>
<p class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt; mso-layout-grid-align: none;"><span style="font-family: &quot;Arial&quot;,&quot;sans-serif&quot;; color: black; font-size: 10pt; mso-ansi-language: EN-US;">and return the copy of this questionnaire to your physician.</span><strong> </strong></p>
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