Sleep Difficulty and Marijuana Use - Anonymous Questionnaire

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* 1. Have you recently stopped using marijuana after a period of regular use?

Yes

No, I'm still using marijuana

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* 2. What is your primary problem with sleep?

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* 3. How long have you had the sleep problem?

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* 4. Have you experienced any of the following?

	Yes	No
Touble getting to sleep at night	Touble getting to sleep at night Yes	Touble getting to sleep at night No
Long periods when you wake up and are not able to return to sleep	Long periods when you wake up and are not able to return to sleep Yes	Long periods when you wake up and are not able to return to sleep No
Wake up often during the night	Wake up often during the night Yes	Wake up often during the night No
Wake up too early and can't fall back asleep	Wake up too early and can't fall back asleep Yes	Wake up too early and can't fall back asleep No
Fatigue or excessive daytime tiredness	Fatigue or excessive daytime tiredness Yes	Fatigue or excessive daytime tiredness No
Vivid or disturbing dreams	Vivid or disturbing dreams Yes	Vivid or disturbing dreams No
Nighttime sweating	Nighttime sweating Yes	Nighttime sweating No

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* 5. Do you feel dependent on marijuana for a good night's sleep?

Yes

Other (please specify)

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* 6. What is your gender?

Female

Male

Other (specify)

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* 7. What is your age?

18 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 to 74

75 or older

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* 8. How long have you been using marijuana? (Please select the closest estimate.)

0-6 months

7-12 months

1-2 years

3-5 years

6-10 years

11+ years

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* 9. In the past year, how frequently have you used marijuana on average?

Multiple times a day

Once a day

Four to six times per week

Two to three times per week

One time per week

Two to three times per month

One time per month

Seven to eleven times this year

Three to six times this year

One to two times this year

I have used marijuana but not in the past year

I have never used marijuana

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* 10. In the past 60 days, how frequently have you used marijuana?

Multiple times a day

Once a day

Four to six times per week

Two to three times per week

One time per week

Two to three times per month

One time per month

One time in the past 60 days

I have not used marijuana in the past 60 days

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* 11. Have you used marijuana to improve sleep?

Yes

If yes, please comment

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* 12. For what purpose do you use marijuana?

Medicinal purposes only

Recreational purposes only

Both recreational and medicinal purposes

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* 13. How available is marijuana to you if you want to get it?

Readily available; I can get marijuana any time I want it.

Somewhat available; I can usually get marijuana when I want it, but sometimes it

Can be difficult.

Slightly available; I can sometimes get marijuana when I want it, but usually it is difficult.

Not very available; it is very difficult for me to get marijuana when I want it.

Not at all available; it is impossible to get marijuana.

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* 14. In what country do you live?

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* 15. Can we share your responses with our community (anonymously)?

Yes

No, I'd prefer it stay private

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* 16. Optional: Enter your email address to receive information about products we're developing to reduce withdrawal symptoms when quitting weed (we promise not to SPAM you).