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Sleep Revolution Sleep Quality Questionnaire

This appendix contains a 9 question sleep quality questionnaire developed by a sleep medicine professor to help users assess their sleep. The questionnaire asks about time taken to fall asleep, waking up during the night, waking up earlier than intended, frequency of sleep problems, rating of sleep quality, and how sleep problems have affected mood, concentration, productivity, and level of trouble. Scores are totaled and correspond to severity of sleep problems, with 0-9 indicating severe problems and needing help, 10-18 indicating some problems to examine, and 19-27 indicating generally good sleep but room for improvement.

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Rhina
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254 views

Sleep Revolution Sleep Quality Questionnaire

This appendix contains a 9 question sleep quality questionnaire developed by a sleep medicine professor to help users assess their sleep. The questionnaire asks about time taken to fall asleep, waking up during the night, waking up earlier than intended, frequency of sleep problems, rating of sleep quality, and how sleep problems have affected mood, concentration, productivity, and level of trouble. Scores are totaled and correspond to severity of sleep problems, with 0-9 indicating severe problems and needing help, 10-18 indicating some problems to examine, and 19-27 indicating generally good sleep but room for improvement.

Uploaded by

Rhina
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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APPENDICES

APPENDIX A

SLEEP-QUALITY QUESTIONNAIRE

This sleep-quality questionnaire—­ t he Sleep Condition


Indicator—­was developed by Colin Espie, professor of sleep
medicine at the University of Oxford and a cofounder of the
sleep-education app Sleepio. Consider it a helpful, science-­
backed tool to start a conversation with yourself, your family,
and your friends, and a useful reference as you take steps to
renew or sustain your relationship with sleep.
To start, circle the most accurate response for each question.
At the end, add up your points to get your sleep assessment,
along with tips for improvement.

Thinking about a typical night in the last month . . .

1. How long does it take you to fall asleep?


0–­15 min. 4 points
16–­30 min. 3 points
31–­45 min. 2 points
46–­60 min. 1 point
>60 min. 0 points

2. If you then wake up one or more times during the


night, how long are you awake in total? (Add up all the
time you are awake.)
0–­15 min. 4 points
16–­30 min. 3 points
31–­45 min. 2 points
46–­60 min. 1 point
>60 min. 0 points

Excerpted from THE SLEEP REVOLUTION by Arianna Huffington.

Huff_9781101904008_3p_all_r1.e.indd 287 1/28/16 9:16 AM


288  APPENDICES

3. If your final wake-­up time occurs before you intend to


wake up, how much earlier is this?
I don’t wake up too early/Up to 15 min. early 4 points
16–­30 min. early 3 points
31–­45 min. early 2 points
46–­60 min. early 1 point
>60 min. early 0 points

4. How many nights a week do you have a problem with


your sleep?
0–­1 4 points
2 3 points
3 2 points
4 1 point
5–­7 0 points

5. How would you rate your sleep quality?


Very good 4 points
Good 3 points
Average 2 points
Poor 1 point
Very poor 0 points

Thinking about the past month, to what extent has poor sleep . . .

6. affected your mood, energy, or relationships?


Not at all 4 points
A little 3 points
Somewhat 2 points
Much 1 point
Very much 0 points

7. affected your concentration, productivity, or ability to


stay awake?
Not at all 4 points
A little 3 points

Excerpted from THE SLEEP REVOLUTION by Arianna Huffington.

Huff_9781101904008_3p_all_r1.e.indd 288 1/28/16 9:16 AM


Appendix A  289

Somewhat 2 points
Much 1 point
Very much 0 points

8. troubled you in general?


Not at all 4 points
A little 3 points
Somewhat 2 points
Much 1 point
Very much 0 points

Finally . . .

9. How long have you had a problem with your sleep?


I don’t have a problem/<1 month 4 points
1–­2 months 3 points
3–­6 months 2 points
7–­12 months 1 point
>1 year 0 points

Now add up your total score and enter it here: _________

Use the following as a guide:

0–­9 Your sleep problems seem to be severe. You should


definitely try to get some help.
10–­18 You have some sleep problems. It’s important to
examine your sleep habits and see how you can
make changes.
19–­27 Your sleep is in good shape, but there are still
many steps you can take to make it even better.

28–­36 Your sleep is in great shape. Keep doing what


you’re doing and spread the word!

For more information, go to the Sleepio app or www.sleepio.com.

Excerpted from THE SLEEP REVOLUTION by Arianna Huffington.

Huff_9781101904008_3p_all_r1.e.indd 289 1/28/16 9:16 AM

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