Tell me how you sleep and I'll tell you who you are...

How many hours of sleep are you now getting in a typical night?

• 5 or less
• 5-7
• 7-9

Do you feel you are currently having a problem with your sleep?

• Yes
• No

Do you have difficulty falling asleep?

• Somewhat (Once in a while)
• Yes, quite often
• Only Lately
• No

If you do, what are some potential causes?

Please select all that apply.

• Stress (Schoolwork, projects)
• Personal Problems (relationships, family)
• Upcoming events
• Insomnia
• Environmental factors (bed, noises, roomate, atmosphere, party next door)

How long does it take for you to fall asleep?

• 0-5 min
• 5- 10 min
• 10-15 min
• 15-20 min
• 20 min to more

Do you wake up in the middle of the night?

• Yes
• No

When you do, what causes it?

Please select all that apply.

• Noise
• Heat
• Roomate
• Light
• Dreams/ Nightmares
• Aches/Pains

Do you feel rested after a night of sleep?

Please select all that apply.

• Always
• Most of the time
• Sometimes ( Once in a while)
• No

Is it easy for you to wake up in the mornings?

• Yes
• No

You wake up:

• By yourself
• Alarm clock

What are the words that best describe what you feel when you wake up?

Please select all that apply.

• Drowsey
• Tired
• Grouchy
• Energetic
• Refreshed
• Alert
• Rested
• Lost, confused

How do you feel throughout the day when you don't sleep enough?

Please select all that apply.

• Grouchy, grumpy
• Lazy, unwilling to do anything
• Lost, disoriented.
• Unable to concentrate
• Can't get things done
• Helpless
• Lack of energy
• Perfectly fine, just tired

Do you take naps? If so for how long?

Please select all that apply.

• 10-20 min
• 20-40min
• 40- 60 min
• 60 min to more
• I don't take naps

Where do you usually sleep?

Please select all that apply.

• On my bed
• On the couch
• On a chair
• Wherever I can lie down

Do you have a consistent sleeping schedule?

Please select all that apply.

• Yes, always sleep and wake up around the same time
• I try to stick with one most of the times
• No, I sleep whenever I'm tired

How important is you bed for you?

• Very Important
• Somewhat important
• Doesn't matter

Where would you go if you need a new mattress?

• Sears
• Ikea
• Bay
• The Brick
• Sleep Country
• Other

Do you think having a good mattress is important for your sleep?

• Yes
• No