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Bedtime Habits and Sleep Quality Survey
Purpose: This anonymous survey is being conducted for a scientific method research project examining how bedtime habits affect sleep quality in adults. Participation is voluntary and responses will remain anonymous.
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1.
What is your age range?
(Required.)
18–24
25–34
35–44
45–54
55–64
65+
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2.
What best describes your work schedule?
(Required.)
Day shift
Evening shift
Night shift
Rotating shifts
Student
Not currently employed
Other
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3.
What activity do you most commonly do within 30 minutes before going to sleep?
(Required.)
Listening to relaxing music or sounds
Listening to podcasts or audiobooks
Watching TV or videos
Scrolling social media
Reading
No media/activity
Other
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4.
How often do you engage in this bedtime activity?
(Required.)
Never
Rarely
Sometimes
Often
Every night
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5.
On average, how long does it take you to fall asleep after going to bed?
(Required.)
Less than 15 minutes
15–30 minutes
31–60 minutes
More than 60 minutes
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6.
How often do you wake up during the night?
(Required.)
Never
Rarely
Sometimes
Often
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7.
How rested do you usually feel when you wake up?
(Required.)
Very rested
Somewhat rested
Neutral
Tired
Very tired
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8.
On average, how many hours of sleep do you get per night?
(Required.)
Less than 5 hours
5–6 hours
6–7 hours
7–8 hours
More than 8 hours
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9.
How would you rate your overall sleep quality?
(Required.)
Very poor
Poor
Fair
Good
Excellent
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10.
Do you believe your bedtime habits affect your sleep quality?
(Required.)
Yes, positively
Yes, negatively
No noticeable effect
Unsure
11.
Do you have Sleep apnea / CPAP / BiPAP
Yes
No
12.
How often do you feel stress or anxiety negatively affects your sleep quality?
Always
Usually
Sometimes
Rarely
Never
13.
Is there anything else you would like to share about your bedtime habits and sleep quality?