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Diagnose Your Sleep!

 

 

 

Here we go...

Start

Question 1 of 20

First, just a couple of quick questions about you. What is your age?

A

Under 18

B

18 - 24

C

25 - 34

D

35- 44

E

45 - 54

F

55 - 64

G

65 - 74

H

75 and over

Question 2 of 20

And what best describes your gender?

A

Female

B

Male

C

Non-binary

D

Prefer not to say

Sleep Duration & Quality

Part 1

Question 4 of 20

How many hours of sleep have you been getting each night, on average, over the last 2 weeks?

A

Less than 3 hours

B

3 - 6 hours

C

6 - 7 hours

D

7 - 9 hours

E

9 - 10 hours

F

More than 10 hours

Question 5 of 20

In the past two weeks, have you experienced any of the following on at least 3 nights per week?

(Select all that apply)
A

Difficulty falling asleep as quickly as you would like

B

Waking during the night and finding it hard to get back to sleep

C

Waking earlier in the morning than you would like and being unable to get back to sleep

D

Trouble sleeping because of thinking or worrying too much

E

Poor quality sleep that leaves you feeling unrefreshed

F

None of the above

Question 6 of 20

Does your sleep affect your ability to function well during the day?

A

Yes

B

No

Sleep Environment & Sleep Patterns

Part 2

Question 8 of 20

Is your sleep affected or disturbed by any of the following?

(Select all that apply)
A

Stress or worries

B

Depression, anxiety or another mental health condition

C

Chronic pain

D

Physical health condition that disturbs sleep

E

Hot flushes or menopause symptoms

F

Regularly needing the toilet at night

G

Medications (prescribed, over-the-counter, or herbal remedies)

H

Shift work or a job with unusual hours

I

Noise or light pollution I cannot control

J

None of these

Question 9 of 20

How about household members — are any people or pets significantly disturbing your sleep?

(Select all that apply)
A

Caring for an adult (e.g. disabled or elderly relative)

B

Babies under 6 months old

C

Babies aged 6–12 months

D

Infants aged 1–2 years

E

Children aged 2 years or older

F

My partner

G

Pets

H

None of these

Question 10 of 20

If you were well rested and had no responsibilities or obligations, what time would you naturally prefer to go to bed?

A

Earlier than 9pm

B

9pm - 10pm

C

10pm - midnight

D

Midnight - 1am

E

Later than 1am

Question 11 of 20

If you were well rested and had no responsibilities, what time would you naturally wake up without an alarm?

A

Earlier than 6am

B

6am - 7am

C

7am - 9am

D

9am - 10am

E

Later than 10am

Daytime Sleepiness

Part 3

Question 13 of 20

During a typical day, are you likely to fall asleep unintentionally while sitting and talking to someone?

A

Yes

B

No

Question 14 of 20

During a typical day, are you likely to fall asleep unintentionally while sitting still in places like work, meetings, or public spaces?

A

Yes

B

No

Question 15 of 20

During a typical day, are you likely to fall asleep unintentionally in situations that could be dangerous, such as while driving?

A

Yes

B

No

Final Section

Part 4

Question 17 of 20

Which of the following apply to you?

(Select all that apply)
A

I have been told I snore loudly

B

I wake up with a dry mouth in the morning

C

I sometimes wake up at night choking or gasping for air

D

I’ve been told I sometimes stop breathing for short periods during sleep

E

None of the above

Question 18 of 20

In the past month, have you experienced any of the following symptoms?
(noticed either by yourself or an observer)

(Select all that apply)
A

An uncomfortable sensation in the legs with a strong urge to move them, starting or worsening in the evening or night, and improving with movement

B

Distressing nightmares that regularly wake you from sleep

C

Repeated jerking or kicking of your legs or body during sleep (not just turning over or stretching)

D

Pauses in breathing during sleep, noticed by another person

E

Sleepwalking or other activities while asleep

F

Being awake but unable to move your body, when falling asleep or waking up

G

Seeing or hearing things that aren’t real when falling asleep or waking up (such as vivid or frightening images or sounds)

H

Sudden loss of muscle strength (e.g. knees giving way, head dropping, jaw slackening, or collapse) triggered by strong emotions such as laughter, anger, or fear

I

None of the above

Question 19 of 20

Final question! Which of the following apply to you?

(Select all that apply)
A

I’d like to improve my sleep to boost memory and brain performance

B

I’d like to improve my sleep to boost physical performance

C

I'd like to improve my sleep to help with weight loss and reduce unhealthy food cravings

D

I sleep reasonably well at night but still don’t feel my best during the day

E

I sleep reasonably well at night but don’t feel refreshed when I wake up

F

I miss out on sleep because of my schedule or lifestyle (e.g. work, hobbies, social activities)

G

I often feel “tired and wired” and find it hard to switch off

H

None of the above

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