ABOUT YOU
SLEEPING PATTERNS
1) Do you have trouble falling asleep at night?
2) Do you wake in the night and have trouble getting back to sleep?
3) Do you wake very early in the morning, even if you've had very little sleep?
4) Do you find it difficult to 'switch off' your thoughts during the night?
DISTURBANCES 5) Are you woken in the early morning or prevented from getting to sleep by light from outside?
6) Is your sleep disturbed by noise from cars, trains and planes?
7) ) Is your sleep disturbed by noise from other people in the house, neighbours, your children waking in the night or pets?
8) Is your sleep disturbed by your partner e.g. snoring or getting up in the night?
9) Do you feel too hot or cold in the night?
10) Do you get up to use the bathroom more than once in the night?
11) Are you aware of any breathing problems, digestive discomfort or aches and pains in the night?
12) Do you or your partner ever experience your legs feeling restless, twitchy or kicking involuntarily during the night?
ENERGY LEVELS 13) Do you need an alarm clock to wake you in the morning?
14) When you first wake up, do you normally feel drowsy or groggy for the first 30 minutes?
15) Do you feel sluggish until you've had something to eat or drink?
16) Do you experience a drop in energy or lack of focus/difficulty in concentrating during the day?
17 Do you ever feel drained of energy after using a computer ?
LIFESTYLE/EMOTIONAL FACTORS 18) Do you tend to feel emotional distress when you are under pressure (e.g. anger, anxiety, panic)?
19) Has any major event or change in your life ever coincided with problems sleeping?
20) Have you ever suffered from insomnia, bad dreams, disturbed nights or persistent health problems?
