Take this 5 to 10 minute survey to get your breakthrough report on why tryptophan is better than 5-htp.
Initial Insomnia Survey
What is your first name?
OPTIONAL: What is your last name?
Are you interested in insomnia because you or someone you love has insomnia?
You
Someone You Love
Neither of the Above
For simplicity, answer the remaining questions as if the problem is your own.
What is your gender?
Male
Female
Decline to Answer
What is the frequency of your sleep problem?
Monthly
Weekly
Bi-weekly
Daily
Extreme
Don't know
How many years have you had insomnia?
Last few days
Last few weeks
Last few months
About a year
2-5 years
5-10 years
More than 10 years
Don't know
If there was a particular time or event that caused or began the insomnia, please describe it here. (Optional)
Normally, when does the insomnia occur? (check all that apply)
Can't fall asleep after going to bed
Awaken in the middle of night, stay awake for hours
Awake too early in the morning
Can't sleep at all
Can only sleep during the day
Other
Don't know
Other than drugs, what techniques for getting to sleep have you heard of, which have you tried, and which do you use? (Optional. Check any or all that apply.)
Heard_Of.
Tried.
Use.
All
Relaxation techniques
Meditation
Listen to music
Drink warm milk
Get daily physical exercise
Eat turkey before bed
Drink herbal tea
Get a massage
Take a warm bath
Take a hot tub
Sex-alone or with another
Use ear plugs/white noise
Sitting and reading
Watching television
Homeopathy
Flower essences
Energy work
Biofeedback
Supplements
Other
If you answered "Supplements" or "Other", please describe the other techniques.
How effective do you feel the techniques for sleeping you are using are?
Very effective
Somewhat effective
Somewhat ineffective
Very ineffective
Not applicable
Effectiveness
What Over-the-Counter drugs for getting to sleep have you heard of, which have you tried, and which do you use? (Optional. Check any or all that apply.)
Heard_Of.
Tried.
Use.
All
Alluna® Sleep
Benadryl®
Excedrin® PM
Melatonin products
NyQuil®
Nytol®
Simply Sleep®
Sleepinal®
Sominex®
Tylenol® PM
Unisom®
Supplements
Other
If you answered "Supplements" or "Other", please describe the other products.
How effective do you feel the Over the Counter drugs for sleeping you are using are?
Very effective
Somewhat effective
Somewhat ineffective
Very ineffective
Not applicable
Effectiveness
What Prescription drugs for getting to sleep have you heard of, which have you tried, and which do you use? (Optional. Check any or all that apply.)
Heard_Of.
Tried.
Use.
All
Ambien® (zolpidem tartrate)
Ativan® (lorazepam)
Dalmane® (flurazepam)
Desyrel® (trazodone)
Doral® (quazepam)
Elavil® (amitriptyline)
Halcion® (triazolam)
ProSom™ (estazolam)
Restoril® (temazepam)
Soma ® (carisoprodol)
Sonata® (zaleplon)
Valium® (diazepam)
Xanax® (alprazolam)
Other
If you answered "Other", please describe the other medications.
How effective do you feel the Prescription drugs for sleeping you are using are?
Very effective
Somewhat effective
Somewhat ineffective
Very ineffective
Not applicable
Effectiveness
If you use prescription sleep medications, how interested would you be in receiving information that would enable you to stop using them?
Very interested
Somewhat interested
Not too interested
Uninterested
Not applicable
Interest level
Who do you go to for assistance in finding relief for your insomnia? (check all that apply)
MD
Osteopathic Doctor
Chiropractor
Chinese Medicine
Acupuncture
Homeopathist
Energy Worker
Internet
Friends
Discussion Groups
Search engines
Library
Other
If you answered "Other", please describe the other practitioners.
How important is having a support group for insomnia to you?
Very important
Somewhat important
No opinion
They are a distraction
They are a wealth of misinformation.
Importance
Would you be interested in hearing about an essential nutrient that facilitates sleeping that your doctor will not tell you about?
yes
no
Does the stress in your life contribute significantly to your insomnia?
Yes
No
Not sure
Do you suspect that you have had depression in your life?
Yes
.No
At sometime in the past?
Are currently experiencing depression?
Is getting a good night's sleep more important to you than: (check all that apply)
Getting to work on time
Sex
Exercise
Spending time with family
Spending time socializing
None of the above
Not sure
What is your most unanswered question about insomnia?
What is the most useful thing you have discovered about managing your insomnia? How did you hear about it?
What is your age?
under 10
11 - 20
21 - 30
31 - 40
41 - 50
51 - 60
61 - 70
71 - 80
81 - 90
over 90
Don't know
What is your Relationship Situation? (Check as many as apply)
Married
Separated
Divorced
Domestic Partners
Single
Single Parent
Unmarried
Significant Other
Child
Uncertain
How do you feel about your marital/relationship status?
extremely dissatisfied
dissatisfied
neutral
satisfied
extremely satisfied
unsure
How is your sleep when you sleep with:
Better
Worse
Not Applicable
Unsure
Spouse
Alone
Girlfriend/Boyfriend
Cat/Dog/Pet
Child
Other
Are you living with somebody who is disturbing your sleep in some manner? If so, what is their relationship to you?
No
Yes
Many women going through menopause experience difficulty sleeping. If you are a menopausal woman, have you experienced any insomnia because of it?
Yes
No
If you answered "yes" to the previous question about menopause and insomnia, do you have any feedback to share about when it occurs, things that have helped, or ideas about what might be causing the sleeplessness?
Please describe the highest level of your education. (Optional)
High School
Vocational Degree
Associates Degree
Bachelors Degree
Masters Degree
Doctoral Degree
Post-Doctoral Studies
Professional Certification
What is your employment status? (Optional)
Full Time
Part Time
Self Employed
Student
Homemaker
Retired
Disabled
Unemployed
What is your ethnic origin? (Optional)
African American
Asian
Caucasian
Hispanic
Native American
Other
What is your income level? (Optional)
less than $25,000
$25,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
over $100,000
Your feedback about this survey is extremely valuable to us!
Yes
No
Did you enjoy taking this survey?
Did you find any of the questions confusing?
Did you learn anything from taking this survey?
How did you hear about this survey?
Search engine
Google Ad
Friend
Other
How long did it take you to take this survey?
5-10 min.
10-15 min.
15-20 min.
more than 20 min.
How many minutes?
If you have specific suggestions about this survey, please tell us about them here. For example, if something was confusing, we'd love for you to tell us what it is!
Thank you for participating in the survey! Your opinions will help in shaping the final content of the Insomnia e-book that we will send you in one month. Please provide us with your Email address so we can send you your FREE e-book! We will never spam you or sell your address. In one month, you will receive a baseline sleep diagnostic to fill out, and when we receive your response to it, we will send you the e-book immediately. Type in email address here:
All information is confidential.
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