THE HEALTH FAIRY
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Sleep Questionnaire
Sleep Questionnaire
1. How easy do you find it to fall asleep at night?
Easily
After some time
with difficulty
2. How often do you wake in the night?
Never
Occasionally
Too many to count
3. Have you started either losing or gaining one or more hours of sleep?
No
Just recently
For a while now
4. Do you snore?
No
Sometimes
Yes
5. Do you wind down properly before bed?
Never
Most of the time
Always
6. How do you generally feel in the morning?
Refreshed
OK
Lethargic
7. How many caffeinated drinks do you have during the day (including evenings)?
Less than 3
3-6
Over 6
8. How many alcoholic units do you generally have before 5pm?
None
1-2
Over 2
9. How many times a week do you exercise?
None
1-3
Over 3
10. When do you take your exercise?
Daytime/Early evening (before 8pm)
Late evening (after 8pm)
Not applicable
11. Do you feel the need to nap during the day?
Never
Occasionally
Always
12. Throughout the day do you feel
Generally happy
Ok, but easily annoyed
Grumpy and irritable
13. Do you use any technology in the hour before bed?
Never
Most nights
Always
14. Do you ever wake up too hot/too cold in bed? (Disregard the seasons)
Never
Occasionally
Always
15. How old is your current mattress?
Less than five years
6-8 years
Older than this
16. Do you often find yourself eating your meal after 8pm at night?
Never
Sometimes
Always
17. Do you wake with aches and pains?
Yes
Sometimes
No
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