Sleep Health Assessment
Sleep quantity, quality, daytime impact, and habits – the intake for sleep programmes.
4 questions · 1 page · about 2 minutes to answer · fully editable after you start
Sleep problems hide behind normal-sounding numbers, so this assessment asks beyond hours: how long falling asleep takes, night waking, how mornings actually feel, and the daytime impact – nodding off, concentration, mood – that defines whether sleep is a problem at all. Habit questions (screens, caffeine, schedule regularity) map the levers.
For sleep clinics and wellness programmes alike, the daytime-impact score triages who needs education versus clinical follow-up.
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Page 1
Your sleep, honestly
This assessment asks about your sleep and how you feel during the day. Your answers help identify what might be getting in the way of a good night's rest. It takes about 2 minutes. This form is not an emergency service. If you need urgent medical help, call your local emergency number.
Q1.On a typical night, how much sleep do you get?*
- Under 5 hours
- 5 to under 6 hours
- 6 to under 7 hours
- 7 to under 8 hours
- 8 hours or more
Q2.How often do these happen?*
| Rarely | Weekly | Most nights/days | |
|---|---|---|---|
| Taking 30+ minutes to fall asleep | |||
| Waking in the night and struggling to return | |||
| Waking exhausted despite time in bed | |||
| Fighting sleepiness during the day |
Q3.Your habits...
| Rarely | Sometimes | Daily | |
|---|---|---|---|
| Screens in the last hour before bed | |||
| Caffeine after mid-afternoon | |||
| Consistent sleep and wake times |
Q4.What do you think is your biggest sleep disruptor?
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