Sleep Habits and Patterns Assessment

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

• Less than 4 hours

• 5-6 hours

• 7-8 hours

• 9+ hours

How often do you feel tired during the day?

• Every day

• Most days

• Sometimes

• Rarely or never

Do you have trouble falling asleep?

• Yes, every night

• Yes, most nights

• Sometimes

• Rarely or never

Do you use electronic devices within an hour of going to bed?

• Yes, always

• Yes, most of the night

• Sometimes

• Never

Do you consume caffeine to stay awake during the day?

• Yes, multiple times a day

• Yes, 2-3 times a day

• Yes, one daily

• Rarely or never