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Pathways to Sleep Version 5

Pathways to Sleep 5

1.What is your gender?
2.What is your age?
3.Please rate the overall quality of your sleep every night.
Very Low: difficult to fall asleep; often wake up;shot night of sleep; very tired when wake up
Moderately Low: fall asleep slowly; wake up at least three time; often want more sleep.
Moderately High: Usually fall asleep easily; wake up once or twice; usually wake refreshed
High: Easily fall asleep; remain asleep for full night (at least 7 hours) and wake fully refreshed
4.Please check any of the following that typifies your usual experience of sleep:
5.Component One: The following list of pathways to sleep concern healthy habits. Please rate each one as to your own experience of its effectiveness in promoting a high quality night of sleep. Leave the item blank if you have no experience with it.
Dangerous
Not Effective
Minimally Effective
Moderately Effective
Highly Effective
Physical Movement: Planned Exercise
Physical Movement: Accompanies Project or Hobby/Advocation
Physical Movement: Part of my Regular Paid Job
Mindfulness/Meditation Practices
Stress Reduction Practices
Planning for Time Zone Changes When Traveling: Shift Sleep Gradually to 
Time Zone Destination
Planning for Time Zone Changes When Traveling: Take Medication (such as Melatonin) for Jet Lag
Addressing Problems Associated with Allergies: Take Allergy Medications (Prescription)
Addressing Problems Associated with Allergies: Take Allergy Medications (Non-Prescription)
Addressing Problems Associated with Allergies: Clear Nostrils with Nasal Wash
Addressing Problems Associated with Allergies: Prepare Strategy for Addressing Sneezing and Coughing When in Bed
Sleep Cycle: Discover Your Own Sleep Cycle
Sleep Cycle: Establish Regular Time Going to Sleep and Waking Up Based on Cycle
Abstaining from Alcohol at Least 3 Hours Before Going to Bed
Reduce Caffeine Intake
Avoid Caffeine after Noon/1 pm
Set an Early Meal Time (At Least 2 hours Before Going to Bed)
Eat Food with Sleep-Inducing Properties: Tryptophan (Turkey)
Eat Food with Sleep Inducing Properties: Cherry Juice
Engage a Sleep Inducing Diet: High Fiber Foods
Engage a Sleep Inducing Diet: Low Sugar Foods
Engage a Sleep Inducing Practice: Meditation
Engage a Sleep Inducing Practice: Yoga
6.Component Two: The following list of pathways concern ways in which to prepare for sleep. Please rate each one as to your experience regarding its effectiveness in promoting a high quality night of sleep. Leave the item blank if you have no experience with it.
Dangerous
Not Effective
Minimally Effective
Moderately Effective
Highly Effective
Aviod Extended Naps During the Day
Reading Before Bedtime
Relaxing Activities Before Bedtime
Temperature Transition: From Hot (Bath/Shower) to Cold (Bedroom)
Temperature Transition: From Hot (Hot Tub/Spa) to Cold (Bedroom)
Temperature Transition: From Hot (Sauna) to Cold (Bedroom)
Temperature Transition: From Cold (Outdoors) to Warm (Bedroom)
Focal Heat: Warm/Hot Compact Over Face/Head
Focal Heat: Hot Patch/Hot Pad/Hot Water Bottle
Soaking Feet Before Going to Bed
Appreciative Reflection:: Positive/Hopeful Thoughts and Feelings [such as 3 Positive Things During the Day]
Appreciative Reflection: "Counting Your Blessings Instead of Sheep"
Appreciative Reflection: Say Something Positive to Your Significant Other Before Going to Bed
Achievement: Check list for the Day (Prepare a List of Tasks Completed During the Day Before Going to Bed)
Achievement: Check list for the Day (Prepare but Find a Way to Set Aside the LIst of Tasks Completed During the Day Before going to Bed
Achievment: Checklist for the Day (Prepare a List of Tasks to Be Completed Tomorrow Before Going to Bed)
Abstain from Activities Before Going to Bed: Don't Watch TV
Abstain from Activities Before Going to Bed: Don't work on the Computer or Engage Social Media
Go to Bathroom Before Going to Bed
Food to Eat 1/2 Hour Before Going to Bed: Cherries
Food to Eat 1/2 Hour Before Going to Bed: Pineapple
Food to Eat 1/2 Hour Before Going to Bed: Walnuts
Food to Eat 1/2 Hour Before Going to Bed: Bananas
Food to Eat 1/2 Hour Before Going to Bed: Cereal and Milk
Food to Eat 1/2 Hour Before Going to Bed: Cheese and Crackers
Food to East 1/2 Hour Before Going to Bed: Hot Chocolate or Hot Milk
7.Component Three: The following list of pathways contains ways in which to sustain sleep once you have fallen asleep. Please rate each one as to your experience regarding its effectiveness in promoting a high quality night of sleep. Leave the item blank if you have no experience in using it.
Dangerous
Not Effective
Minimally Effective
Moderately Effective
Highly Effective
Teeth and Jaw Alignment: Over-the-Counter
Teeth and Jaw Alignment: Custom Made by Dental Service
Temperature Transition Inside Bedroom: From Cold (Bedroom) to Warm (Bed with Sufficient Blankets/Quilt)
Dark Room: MInimal Light of Any Kind
Soft Light in Room: Colored (e.g. Salt Lamp)
Soft Light in Room: Night Light
Soft Light in Room: Rhythmic Light or Projection of Star Formations
Comfortable Bed: Adjustable (Variable Softness)
Comfortable Bed: Multiple Layers of Mattress/Box Springs
Comfortable Bed: Adjustable Angle(s)
Configuration of Bed: Adequate Length
Configuration of Bed: Appropriate Width (Single, Double, Queen, King, Super King)
Comfortable Pillows
Configuration of Pillows: Number of Pillows on the Bed (Including Side-Pillows)
Configuration of Pillows: Diversity of Pillows on the Bed (Size, Softness, Shape) or Sleep Pod
Comfortable Sheets: Thread Count
Comfortable Sheets: Texture/Compositon (e.g. Silk, Flannel, Cotton, Mixed)
Comfortable Sheets: Ventilation (Sheet easily disperses moisture)
Sleeping Companion: Lying Close to Another Person (Snuggling)
Sleeping Companion: Feeling Intimate/Safe/Trusting Beside Another Person
Sleeping Companion: Lying Beside a Favorite Pet
Sleeping Position (Relates to Breathing, Snoring, Muscular Tension): Frequent Change in Position
Sleeping Position (Relates to Breathing, Snoring, Muscular Tension): Lying on Your Back
Sleeping Position (Relates to Breathing, Snoring, Muscular Tension): Lying on Your Side
Sleeping Position (Relates to Breathing, Snoring, Muscular Tension): Lying on Your Belly 
Quiet Room: No Sounds
Gentle Music: Lulliby
Relaxing Music: Easy Listening/Meditative
Interesting Music: Distraction from Failure to Fall Asleep (Distracts Us from Worryng About Falling Aleep)
Boring Spoken Words (Often Recorded and Replayed)
Relaxing/Distracting Imagery/Fantasy While Falling Asleep: Sexual Fantasy
Relaxing/Distracting Imagery/Fantasy While Falling Asleep: Beautiful/Tranquil Settings Imagined or Recollected
Relaxing/Distracting Imagery/Fantasy While Falling Asleep: Special Moment or Event Remembered or Even Replayed
Relaxing/Distracting Imagery/Fantasy While Falling Asleep: Replaying Scene from Movie, TV, Theater
Falling Asleep When Trying to Stay Awake: Watching Televised Program (e.g. Movie) or Listening to Music
Falling Asleep When Trying to Stay Awake: Reading Book
Falling Asleep When Trying to Stay Awake: Waiting for Someone Else to Come to Bed or Arrive Home
8.Component Four: The following list of pathways contains ways in which sleep is aided by some external device or ingested ingredient. Please rate each item regarding its effectiveness in promoting a high quality night of sleep. Leave the item blank if you have no experience with it.
Dangerous
Not Effective
Minimally Effective
Moderately Effective
Highly Effective
CPAP
Other Air-Driving Devices: Not CPAP
Electronic Devices: Eye Stimulation
Essential Oils/Herp Oils
Melatonin
Natural/Herbal Sleep Aids: Single Ingredient (L-Ornithine)
Natural/Herbal Sleep Aids: Single Ingredient (Valerian)
Natural/Herbal Sleep Aids: Single Ingredient (Turmeric)
Natural/Herbal Sleep Aids: Single Ingredient (Hops)
Natural/Herbal Sleep Aids: Single Ingredient (Lavender)
Natural/Herbal Sleep Aids: Single Ingredient (Rosemary)
Natural/Herbal Sleep Aids: Single Ingredient (Passion Flower)
Natural/Herbal Sleep Aids: Single Ingredient (Calcium)
Natural/Herbal Sleep Aids: Single Ingredient (Magnesium)
Natural/Herbal Sleep Aids: Single Ingredient (St. John's Wort)
Natural/Herbal Sleep Aids: Mixed Ingredients 
Non -Benzodiazepine Sedative: Ambien (Zolpiderm)
Non -Benzodiazepine Sedative: Lunesta
Trazadone
Benzodiazepine Sedative
Over-The-Counter Sleep Aids with Alcohol
Over-The-Counter Sleep Aids With Neither Alcohol nor Pain Relief: Anti-Histamine (Diphenhydramine such as Benadryl, Aleve PM)
Over-The-Counter Sleep Aids With Pain Relief: Acetaminophen (Tylenol PM, Excedrin PM/Generic)
Over-The-Counter Sleep Aids With Pain Relief: Ibuprofen (Advil PM/Generic)
9.If you would like to receive a copy of the complete Pathways to Sleep Inventory (including expert ratings, cost, access and updated user ratings) that can be used in your own sleep management as well as work with clients, just provide us with your email address and we will send you a copy once the results have been tabulated and revised Inventory has been prepared.