QUIZ: Hacking Sleep Patterns

What is the average number of hours you sleep in a day? *

How many hours of sleep is normal for someone of your age each night? *

Less than 3

4-5

6-7

8-9

10+

On a scale from 1-10, rate your overall sleep quality. (1=Sleep deprived,
10=Feeling So Rested!) *

Do you use an alarm clock? *

Yes

No

How would you rate your level of energy in the morning? *

Low Energy

Medium Energy

High Energy

How would you describe your usual sleep patterns throughout the week? *

What time do you usually go to bed on weekdays? *

What time do you usually go to bed on weekends? *

What time do you usually wake up on weekdays? *

Does this pattern change on the weekends? *

Yes

No

Do your routine change on the weekend, or on certain days? *

How long does it usually take for you to fall asleep once you have decided to? *

Less than 10mins

10mins – 15mins

15mins – 30mins

30mins – 1 hour

More than 1 hour

How long does it usually take you to “get going” after you get out of bed? *

Immediately

10mins – 30mins

30mins – 1 hour

1-2 hours

More than 2 hours

If you were able to sleep longer, do you believe you would you feel more rested? *

Yes

No

What are some common tactics you have put in place to help get you into a sleep mode? *

Watching TV

Viewing social media

Reading a book

Listening to music

Playing white noise

Staying up later

What else is going on when you are trying to fall asleep? *

Are you currently using any sleep aids to help? *

Nightmask

Prescription Sleep Aid

Melatonin Supplements

Vitamin/Mineral Supplements

"Noise Creator" (ex: fan)

Do you ever purposefully take naps? *

Yes

No

On average, how long do your naps last? *

5mins – 10mins

10mins – 30mins

30mins – 1 hour

1hour – 2 hour

More than 2 hours

Who do you share a bed with? *

Sleep alone

Share with partner

Share with pet

How easy is it to disturb your sleep? *

I'm up at the slightest disturbance

I'm moderately sensitive to disturbances

I'm fairly resilient to disruptions

I can sleep through anything

Do you experience any of these sleep related conditions? (Select all the apply) *

Sleep Walking

Sleep Talking

Vivid Dreams

Nightmares

Do you regularly struggle with staying asleep all night? *

Yes

No

How often do you wake up during the night? *

Just sometimes

At lease once per night

Multiple times each night

What comments or feedback have we missed that will help us Partner together better? (100 to 1,200 characters) *

Rejuvenating Sleep