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Psy. D., ABPP
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All mental health problems are more severe and harder to treat when there are disturbances of sleep.
Moderate to excessive caffeine use may cause initial insomnia and a reduction in a slow wave (i.e., deep, restorative) sleep.

This questionnaire allows the clinician to rapidly determine daily caffeine consumption.
Monitoring this can be a high yield intervention.

This questionnaire is free and was created in the Adobe Acrobat format (pdf).
If you do not have Adobe Acrobat, you can download it for free by
clicking on the link below.

http://www.adobe.com

To download the questionnaire, please click here.

For a direct version without downloading the Adobe reader, click the image below…