The Sleep Questionnaire

Most people have an idea about whether their sleep is good or bad,

but how bad is it really?

Take this questionnaire and find out!

1 / 5

I wake up at least twice a night to use the toilet

Yes

2 / 5

I wake up at least once during the night and cannot fall back asleep.

No, I usually sleep soundly through the night

I wake up to pee but I usually fall back asleep without problems

Yes, I wake up and it sometimes takes me more than 30 mins to back asleep

3 / 5

Check all of the below sleep aids that you take to help you fall asleep:

I don't take anything for sleep.

Magnesium

5-HTP

Any type of herbs or herbal blend, except for valerian root.

Valerian root

Other non-pharmaceutical supplement

Melatonin

Pharmaceutical drugs of any type, including sedatives, benzos and antidepressants

4 / 5

I have problems falling asleep at night.

No, I usually fall asleep within 10 minutes of going to bed, without the use of any sleep aids.

No, but that's because I'm using sleep medication

Yes, I struggle to sleep and typically need at least 20 minutes to fall asleep.

5 / 5

Which of the following applies to you?

I don't drink anything with caffeine at all.

I drink beverages with caffeine but I function very well without them.

I need to have coffee or something with caffeine, or at least some food around 3-5pm in the afternoon, otherwise I will need a nap

I need to have coffee or something with caffeine first thing in the morning, otherwise I cannot function.

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