Sleep Questionnaire Form

Sleep Questionnaire Form
1.Approximately what time would you get up if you were entirely free to plan your day?
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5:00-6:30 a.m.
6:30-7:45 a.m.
7:45-9:45 a.m.
9:45-11:00 a.m.
11:00 a.m.-12:00 noon
12:00 noon-5:00 a.m.
2.Approximately what time would you go to bed if you were entirely free to plan your evening?
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8:00-9:00 p.m.
9:00-10:15 p.m.
10:15 p.m.-12:30 a.m.
12:30-1:45 a.m.
1:45-3:00 a.m.
3:00 a.m.-8:00 p.m.
3.If you usually have to get up at a specific time in the morning, how much do you depend on an alarm clock?
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Not at all
Slightly
Somewhat
Very much
4.How easy do you find it to get up in the morning (when you are not awakened unexpectedly)?
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Very difficult
Somewhat difficult
Fairly easy
Very easy
5.How alert do you feel during the first half hour after you wake up in the morning?
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Not at all alert
Slightly alert
Fairly alert
Very alert
6.How hungry do you feel during the first half hour after you wake up?
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Not at all hungry
Slightly hungry
Fairly hungry
Very hungry
7.During the first half hour after you wake up in the morning, how do you feel?
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Very tired
Fairly tired
Fairly refreshed
Very refreshed
8.If you had no commitments the next day, what time would you go to bed compared to your usual bedtime?
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Seldom or never later
Less than 1 hour later
1-2 hours later
More than 2 hours later
9.You have decided to do physical exercise. A friend suggests that you do this for one hour twice a week, and the best time for him is between 7-8 a.m. Bearing in mind nothing but your own internal "clock," how do you think you would perform?
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Would be in good form
Would be in reasonable form
Would find it difficult
Would find it very difficult
10.At approximately what time in the evening do you feel tired, and, as a result, in need of sleep?
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8-9 p.m
9-10:15 p.m
10:15 p.m.-12:45 a.m.
12:45-2:00 a.m.
2-3 a.m.
11.You want to be at your peak performance for a test that you know is going to be mentally exhausting, and will last two hours. You are entirely free to plan your day. Considering only your internal "clock," which one of the four testing times would you choose?
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8-10 a.m.
11 a.m.-1 p.m.
3-5 p.m.
7-9 p.m.
12.If you got into bed at 11 p.m., how tired would you be?
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Not at all tired
A little tired
Fairly tired
Very tired
13.For some reason you have gone to bed several hours later than usual, but there is no need to get up at any particular time the next morning. Which one of the following are you most likely to do?
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Will wake up at usual time, but will not fall back asleep
Will wake up at usual time and will doze thereafter
Will wake up at usual time, but will fall asleep again
Will not wake up until later than usual
14.One night you have to remain awake between 4-6 a.m. to carry out a night watch. You have no time commitments the next day. Which one of the alternatives would suit you best?
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Would not go to bed until the watch was over
Would take a nap before and sleep after
Would take a good sleep before and nap after
Would sleep only before the watch
15.You have to do two hours of hard physical work. You are entirely free to plan your day. Considering only your internal "clock," which one of the following times would you choose?
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8-10 a.m.
11 a.m.-1 p.m.
3-5 p.m.
7-9 p.m.
16.You have decided to do physical exercise. A friend suggests that you do this for one hour twice a week. The best time for her is between 10-11 p.m. Bearing in mind only your own internal "clock," how well do think you would perform?
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Would be in good form
Would be in reasonable form
Would find it difficult
Would find it very difficult
17.Suppose you can choose your own work hours. Assume that you work a five-hour day (including breaks), your job is interesting, and you are paid based on your performance. At approximately what time would you choose to begin?
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5 hours starting between 4 a.m. and 8 a.m.
5 hours starting between 8 a.m. and 9 a.m.
5 hours starting between 9 a.m. and 2 p.m
5 hours starting between 2 p.m. and 5 p.m.
5 hours starting between 5 p.m. and 4 a.m.
18.At approximately what time of day do you usually feel your best?
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5-8 a.m.
8-10 a.m.
10 a.m-5 p.m.
5-10 p.m.
10 pm-5 a.m
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I am human

1.Approximately what time would you get up if you were entirely free to plan your day?

2.Approximately what time would you go to bed if you were entirely free to plan your evening?

3.If you usually have to get up at a specific time in the morning, how much do you depend on an alarm clock?

4.How easy do you find it to get up in the morning (when you are not awakened unexpectedly)?

5.How alert do you feel during the first half hour after you wake up in the morning?

6.How hungry do you feel during the first half hour after you wake up?

7.During the first half hour after you wake up in the morning, how do you feel?

8.If you had no commitments the next day, what time would you go to bed compared to your usual bedtime?

9.You have decided to do physical exercise. A friend suggests that you do this for one hour twice a week, and the best time for him is between 7-8 a.m. Bearing in mind nothing but your own internal "clock," how do you think you would perform?

10.At approximately what time in the evening do you feel tired, and, as a result, in need of sleep?

11.You want to be at your peak performance for a test that you know is going to be mentally exhausting, and will last two hours. You are entirely free to plan your day. Considering only your internal "clock," which one of the four testing times would you choose?

12.If you got into bed at 11 p.m., how tired would you be?

13.For some reason you have gone to bed several hours later than usual, but there is no need to get up at any particular time the next morning. Which one of the following are you most likely to do?

14.One night you have to remain awake between 4-6 a.m. to carry out a night watch. You have no time commitments the next day. Which one of the alternatives would suit you best?

15.You have to do two hours of hard physical work. You are entirely free to plan your day. Considering only your internal "clock," which one of the following times would you choose?

16.You have decided to do physical exercise. A friend suggests that you do this for one hour twice a week. The best time for her is between 10-11 p.m. Bearing in mind only your own internal "clock," how well do think you would perform?

17.Suppose you can choose your own work hours. Assume that you work a five-hour day (including breaks), your job is interesting, and you are paid based on your performance. At approximately what time would you choose to begin?

18.At approximately what time of day do you usually feel your best?

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