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Sleep Survey
625
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Created by
NathanB
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Snore....
1
What is your gender?
Male
Female
2
How old are you?
Under 12
13-18
19-30
31-45
46-55
Over 56
3
How long do you sleep on weekdays? (on average)
Less than 2 hours
2-4 hours
5-6 hours
7-9 hours
10-11 hours
Over 12 hours
4
How long to you sleep on weekends? (on average)
Less than 2 hours
2-4 hours
5-6 hours
7-9 hours
10-11 hours
Over 12 hours
5
When you wake up, do you eat breakfast?
Yes
No
Sometimes, if I'm hungry
6
Do you drink coffee after you wake up?
Eww! No!
No
Yes
7
If you answered 'Yes' to question 6, how many cups of coffee?
1-2
3-4
5-7
8-9
Over 10
8
Where do you usually sleep?
My bed, duh!
Couch
Recliner
Chair
Floor
Where ever I pass out at!
9
Do you take naps?
Yes
No
On occassion
10
How long are your naps usually?
Less than 15 minuits
15-45 minuits
45 minuits - 1 hour
1-2 hours
Over 2 hours
I don't take naps
11
Do you snore?
Yes
No
Somtimes
I don't know
12
What position do you sleep in? (usually)
On my back
On my side, facing left
On my side, facing right
On my stomach
Don't know
13
Have you ever experinced Sleep Paralysis?
Yes
No
What the hell is that?
14
How often do you experince Sleep Paralysis?
1-2 times a year
Once every few months
A few times per month
Once a week
A few times a week
Every time I sleep
Never
15
Do you take sleeping medication to help you fall asleep?
Yes
No
I used too, but now I don't
16
Do you have insomnia?
Yes
No
Off and on
17
Are you sleepy during the day?
Yes
No
Sometimes
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