Sleep Questionnaire1. How easy do you find it to fall asleep at night? Easily After some time with difficulty2. How often do you wake in the night? Never Occasionally Too many to count3. Have you started either losing or gaining one or more hours of sleep? No Just recently For a while now4. Do you snore? No Sometimes Yes5. Do you wind down properly before bed? Never Most of the time Always6. How do you generally feel in the morning? Refreshed OK Lethargic7. How many caffeinated drinks do you have during the day (including evenings)? Less than 3 3-6 Over 68. How many alcoholic units do you generally have before 5pm? None 1-2 Over 29. How many times a week do you exercise? None 1-3 Over 310. When do you take your exercise? Daytime/Early evening (before 8pm) Late evening (after 8pm) Not applicable11. Do you feel the need to nap during the day? Never Occasionally Always12. Throughout the day do you feel Generally happy Ok, but easily annoyed Grumpy and irritable13. Do you use any technology in the hour before bed? Never Most nights Always14. Do you ever wake up too hot/too cold in bed? (Disregard the seasons) Never Occasionally Always15. How old is your current mattress? Less than five years 6-8 years Older than this16. Do you often find yourself eating your meal after 8pm at night? Never Sometimes Always17. Do you wake with aches and pains? Yes Sometimes NoName First Last Email Consent I agree to the privacy policy.PhoneThis field is for validation purposes and should be left unchanged.
