My sleep habits

Do you go to bed and get at the same time every day?

• Never

• Rarely

• Sometimes

• Often/always

Is your bedroom dark, quiet and at a comfortable temperature to sleep?

• Never

• Rarely

• Sometimes

• Often/Always

Are there any devices in your bedroom (TV, phone, tablet, computer etc.)?

• Often/Always

• Sometimes

• Rarely

• Never

Do you eat large meals or consume caffeine or energy drinks before bed?

• Often/Always

• Sometimes

• Rarely

• Never

Are you physically active during the day?

• Never

• Rarely

• Sometimes

• Often/Always

On average, how much sleep do you get daily?

• Less than 5

• 6 hours

• 7 hours

• 8-10 hours

Do you turn off screens at least 1 hour before bed?

• Never

• Rarely

• Sometimes

• Often/Always

Generally, do you take naps after 2pm?

• Often/Always

• Sometimes

• Rarely

• Never

Do you have an established relaxing bedtime routine (reading, meditation, yoga, stretching, bath etc.)?

• No, I do not have an established relaxing bedtime routine.

• Rarely

• Sometimes

• Yes, I have an established bedtime routine

Do you eat a balanced healthy diet?

• Never

• Rarely

• Sometimes

• Often/Always