Sleep Hygiene Questionnaire
For a restful and rejuvenating sleep you must first identify and eliminate or reduce your sleep obstacles. Please refer to the list of obstacles in Part One of this article. Establishing new sleep habits will require a love of yourself and a meaningful relationship to your health. It will require dedication.
Sleep is a Basic Health Habit.
Sleep Hygiene means the control of all behavioural and environmental factors that precede and may aid or interfere with the quality of your sleep.
Sleep Hygiene Questionnaire
(10 Questions, 5-10 minutes)
- sleeping soundly the entire night
- sleeping soundly with one or two interruptions
- sleeping lightly after interruptions
- unable to fall back to sleep after interruptions
- sleeping 7-8 hours
- sleeping less than 7 hours on a regular basis
2. Do you have difficulty falling to sleep at night?
3. How do you typically feel during waking hours?
- I feel energetic and wide-awake all day
- I feel well rested all day
- I feel tired all day
- I feel tired only in the morning
- I feel tired in the afternoon
4. Do you go to bed and wake up at the same time every night?
- yes, I go to bed and wake up at approximately the same time every night
- no, I go to bed and wake up at approximately the same time on working days but different times on days off work
- no, every night is different
5. You have an important decision to make that will affect your life and it will require careful consideration. When are you most likely to think about it?
- in bed before going to sleep
- in bed after waking up
- in the shower
- during my free time
- in the middle of my busy work day
- during exercise
- at meal time
- at a specific time devoted to examining the pros and cons
6. You have had a stressful week. You have been going to bed late, sleeping poorly and getting up early every day. You would like to get home and go to bed early but you have an invitation to go out. What do you do?
- apologize and decline the invitation
- accept the invitation- you can catch up on sleep another night
- accept the invitation because you feel obliged, but hate yourself for not listening to your body's cries for rest
- accept the invitation, you feel like you can keep this pace forever
7. Do you exercise?
- early morning
- early evening
- late at night
8. You have been having trouble getting to sleep and staying asleep for the past few nights. What do you do?
- call the doctor for a prescription
- buy over-the-counter sleeping pills
- try an herbal remedy
- make an appointment at a sleep clinic
- try all the sleep aids I know
- lie awake at night and suffer
- start using the sleepless nights for productive pursuits, hoping that the sleeplessness will end
10. List the details of your bedroom
11. Score yourself on your basic health habits.
This questionnaire is meant to help you to become more aware of your sleep habits.
Part Three: Sleep Aids For a Restful and Rejuvenating Sleep