Sleep Questionnaire 1. How easy do you find it to fall asleep at night? Easily After some time with difficulty 2. How often do you wake in the night? Never Occasionally Too many to count 3. Have you started either losing or gaining one or more hours of sleep? No Just recently For a while now 4. Do you snore? No Sometimes Yes 5. Do you wind down properly before bed? Never Most of the time Always 6. How do you generally feel in the morning? Refreshed OK Lethargic 7. How many caffeinated drinks do you have during the day (including evenings)? Less than 3 3-6 Over 6 8. How many alcoholic units do you generally have before 5pm? None 1-2 Over 2 9. How many times a week do you exercise? None 1-3 Over 3 10. When do you take your exercise? Daytime/Early evening (before 8pm) Late evening (after 8pm) Not applicable 11. Do you feel the need to nap during the day? Never Occasionally Always 12. Throughout the day do you feel Generally happy Ok, but easily annoyed Grumpy and irritable 13. Do you use any technology in the hour before bed? Never Most nights Always 14. Do you ever wake up too hot/too cold in bed? (Disregard the seasons) Never Occasionally Always 15. How old is your current mattress? Less than five years 6-8 years Older than this 16. Do you often find yourself eating your meal after 8pm at night? Never Sometimes Always 17. Do you wake with aches and pains? Yes Sometimes No Name First Last Email Consent I agree to the privacy policy.PhoneThis field is for validation purposes and should be left unchanged.