Sleep Quality Assessment

How many hours of sleep do you typically get per night?

Less than 5 hours

5-6 hours

6-7 hours

7-8 hours

More than 8 hours

How long does it typically take you to fall asleep?

Less than 10 minutes

10-20 minutes

20-30 minutes

30-60 minutes

More than 60 minutes

How often do you wake up during the night?

Rarely or never

Once per night

2-3 times per night

4-5 times per night

More than 5 times per night

How do you feel when you wake up in the morning?

Refreshed and energetic

Somewhat rested

Neither rested nor tired

Somewhat tired

Very tired and groggy

How consistent is your sleep schedule?

Very consistent (same time every day)

Mostly consistent (within 30 mins)

Somewhat consistent (within 1 hour)

Inconsistent (varies by 1-2 hours)

Very inconsistent (varies greatly)

How comfortable is your sleep temperature?

Perfect - consistently comfortable

Usually comfortable

Sometimes too hot/cold

Often too hot/cold

Very uncomfortable temperature

Do you experience any pain or discomfort after sleeping?

No pain or discomfort

Mild, occasional discomfort

Moderate discomfort some mornings

Regular pain or stiffness

Severe pain most mornings

What's your biggest sleep challenge?

Racing thoughts/stress

Room too bright/noisy

Uncomfortable bed/pillow

Temperature regulation

Physical pain/discomfort