Sleep Assessment – Slumbelry

Part 1: Core Sleep Patterns

1. Over the past month, how long has it usually taken you to fall asleep at night?

Less than 15 minutes 16-30 minutes 31-60 minutes More than 60 minutes

2. Over the past month, how many hours of actual sleep did you usually get at night?

More than 7 hours 6-7 hours 5-6 hours Less than 5 hours

3. Over the past month, how many nights a week did you wake up in the middle of the night or too early in the morning?

Never Less than once a week 1-2 times a week 3 or more times a week

4. When you wake up during the night, how difficult is it for you to fall back asleep?

No difficulty at all A little difficulty Somewhat difficult Very difficult, or I can't fall back asleep

5. Over the past month, how often has your sleep been disturbed because you...

Had bad dreams?

Never Occasionally Frequently Almost Nightly

Felt too hot or too cold?

Never Occasionally Frequently Almost Nightly

Had aches or pains?

Never Occasionally Frequently Almost Nightly

Part 2: Daytime Function & Impact

6. When you wake up in the morning, how rested and refreshed do you feel?

Very rested Fairly rested A little tired Very tired, as if I haven't slept at all

7. Over the past month, how often have you found yourself dozing off during quiet daytime activities (e.g., watching TV, reading)?

Never Rarely Frequently Almost daily

8. To what extent has your sleep problem interfered with your daily functioning (e.g., work performance, mood, social activities)?

Not at all A little Somewhat Very much

9. How worried or distressed are you about your current sleep problem?

Not at all worried A little worried Somewhat worried Very worried and distressed

10. To what extent is your sleep problem noticeable to others (e.g., family, colleagues) in terms of impairing your quality of life?

Not at all noticeable A little noticeable Somewhat noticeable Very noticeable

Part 3: Lifestyle & Behaviors

11. How often do you use electronic devices (phone, computer, TV) within one hour of your bedtime?

Never Sometimes Often Every night

12. How consistent is your sleep schedule (bedtime and wake-up time) between weekdays and weekends?

Very consistent (less than 1-hour difference) Mostly consistent (1-2 hour difference) Somewhat inconsistent (2-3 hour difference) Very inconsistent (more than 3-hour difference)

13. Over the past month, how often did you have caffeinated beverages (coffee, strong tea, energy drinks) after 3 PM?

Never 1-2 times a week 3-4 times a week Almost daily

14. Over the past month, how often did you drink alcohol within two hours of bedtime?

Never Sometimes Often Almost daily

15. How often do you take naps lasting longer than 30 minutes during the day?

Never 1-2 times a week 3-4 times a week Almost daily

16. Do you have a regular, relaxing "wind-down" routine before bed (e.g., warm bath, reading a physical book, listening to calm music)?

Yes, every night Most nights Some nights Never

17. How satisfied are you with your current sleep environment (e.g., light, noise, temperature, comfort)?

Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied

18. Over the past month, how often have you taken something to help you sleep (prescribed, over-the-counter, or supplements)?

Never Less than once a week 1-2 times a week 3 or more times a week

Part 4: Your Improvement Journey

19. Which of the following have you already tried to improve your sleep? (Select all that apply)

Prescription sleeping pills Melatonin or other supplements Herbal teas or drinks Meditation or relaxation exercises White noise or sleep music Aromatherapy (e.g., essential oils) Improving my bedroom environment (e.g., new curtains, bedding) Sticking to a strict sleep schedule Avoiding caffeine or alcohol before bed None of the above

20. What are you most open to trying now? (Select all that apply)

Learning more about the science of sleep Getting personalized lifestyle adjustment tips Trying natural, non-habit-forming sleep products Learning effective relaxation and stress-reduction techniques Considering professional help (from a doctor or therapist)

Comprehensive Sleep Assessment

Part 1: Core Sleep Patterns

1. Over the past month, how long has it usually taken you to fall asleep at night?

2. Over the past month, how many hours of actual sleep did you usually get at night?

3. Over the past month, how many nights a week did you wake up in the middle of the night or too early in the morning?

4. When you wake up during the night, how difficult is it for you to fall back asleep?

5. Over the past month, how often has your sleep been disturbed because you...

Had bad dreams?

Felt too hot or too cold?

Had aches or pains?

Part 2: Daytime Function & Impact

6. When you wake up in the morning, how rested and refreshed do you feel?

7. Over the past month, how often have you found yourself dozing off during quiet daytime activities (e.g., watching TV, reading)?

8. To what extent has your sleep problem interfered with your daily functioning (e.g., work performance, mood, social activities)?

9. How worried or distressed are you about your current sleep problem?

10. To what extent is your sleep problem noticeable to others (e.g., family, colleagues) in terms of impairing your quality of life?

Part 3: Lifestyle & Behaviors

11. How often do you use electronic devices (phone, computer, TV) within one hour of your bedtime?

12. How consistent is your sleep schedule (bedtime and wake-up time) between weekdays and weekends?

13. Over the past month, how often did you have caffeinated beverages (coffee, strong tea, energy drinks) after 3 PM?

14. Over the past month, how often did you drink alcohol within two hours of bedtime?

15. How often do you take naps lasting longer than 30 minutes during the day?

16. Do you have a regular, relaxing "wind-down" routine before bed (e.g., warm bath, reading a physical book, listening to calm music)?

17. How satisfied are you with your current sleep environment (e.g., light, noise, temperature, comfort)?

18. Over the past month, how often have you taken something to help you sleep (prescribed, over-the-counter, or supplements)?

Part 4: Your Improvement Journey

19. Which of the following have you already tried to improve your sleep? (Select all that apply)

20. What are you most open to trying now? (Select all that apply)