Sleep Duration
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How many hours of sleep do you typically get per night? Less than 6 hours 6-7 hours 7-8 hours More than 8 hours
Consistency
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Do you maintain a regular sleep schedule? Yes No
Sleep Environment
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Rate the comfort of your sleep environment on a scale of 1-5 (1 being uncomfortable, 5 being very comfortable). 1 2 3 4 5
Screen Time Before Bed
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Do you limit screen time before bedtime? Yes No
Caffeine and Stimulants
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Do you avoid consuming caffeine or stimulants close to bedtime? Yes No
Bedtime Routine
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Do you have a tranquil bedtime routine? Yes No
Physical Activity
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How often do you engage in regular exercise? Daily 3-4 times a week Rarely
Sleep Disruptions
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Rate the level of disruptions in your sleep environment on a scale of 1-5 (1 being low, 5 being high). 1 2 3 4 5
Heavy Meals Before Bed
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Do you avoid heavy meals close to bedtime? Yes No
Stress Management
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How often do you practice relaxation techniques? Daily Occasionally Rarely
Sleeping Position
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Rate the comfort of your sleeping position on a scale of 1-5 (1 being uncomfortable, 5 being very comfortable). 1 2 3 4 5
Daytime Alertness
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Rate your overall daytime alertness and productivity on a scale of 1-5 (1 being low, 5 being high). 1 2 3 4 5
Snoring and Breathing
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Do you notice snoring or irregular breathing patterns during sleep? Yes No
Morning Feelings
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How do you generally feel upon waking? Refreshed Tired Groggy
Professional Consultation
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Have you consulted with a healthcare professional or sleep specialist about your sleep issues? Yes No
If you are human, leave this field blank.
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