Free Sleep Assessment

1 Do you have difficulties falling asleep? Yes No
2 Do you have difficulties staying asleep throughout the night? Yes No
3 Are you struggling to return to sleep if awaken during the night? Yes No
4 Do you take any prescribed sleeping medication or supplements? Yes No
5 Have you lost interest in socialising, hobbies and physical activities? Yes No
6 Do you feel irritable, sad or moody? Yes No
7 Do you feel nervous, anxious or worried lately? Yes No
8 Do you experience fatigue, exhaustion or sleepiness during daytime? Yes No
9 Do you have a sleep routine like going to bed and waking up at the same time? Yes No
10 Do you have a good understanding of the Circadian Rhythms Yes No
11 Do you watch TV, use the internet or read in bed? Yes No
12 Do you use an eye mask or earplugs in bed? Yes No
13 Do you snore /or anyone witnessed you having breathing pauses during the night? Yes No
14 Have you been diagnosed by any medical conditions that disrupt your sleep? Yes No
15 Do you feel unrefreshed and tired after awakening? Yes No