Sleep Questionnaire for Adults(aged 17yrs+)

General Details

Full Name *

Phone *

Email *

Section 1: General Sleep Patterns

What time do you usually go to bed on weekdays?

Please specify your usual bedtime on workdays (Monday-Friday)

What time do you usually wake up on weekdays?

Indicate your typical wake-up time on workdays (Monday - Friday)

What time do you usually go to bed on weekends?

Mention if your bedtime differs from weekdays.

What time do you usually wake up on weekends?

Specify if you wake up later or at the same time as weekdays.

How long does it take you to fall asleep after going to bed?

Estimate the average time it takes you to fall asleep

Do you wake up during the night? If yes, how often and for how long?

Describe the frequency and duration of night-time awakenings.

Do you take naps during the day? If yes, how long and at what time?

Provide details on your napping habits

Section 2: Sleep Environment and Habits

Do you have a regular bedtime routine? (e.g., reading, relaxation techniques)

List any activities that help you wind down before sleep.

Do you use electronic devices (TV, tablet, phone, gaming console) before bedtime? If yes, how long?

Specify screen usage before bed.

How would you describe your sleep environment? (e.g., dark, quiet, cool, comfortable)

Include details on your bedroom conditions.

Do you consume caffeine, alcohol, or nicotine before bedtime? If yes, how frequently?

List substances consumed before sleep - include frequency and amount.

Do you engage in physical activity or exercise close to bedtime?

Mention if you work out before sleep and its impact on your rest.

Section 3: Sleep-Related Issues

Does you experience difficulty falling and/or staying asleep?

Please explain the above in more detail

Describe how often they struggle to fall asleep and/or stay asleep.

Does you experience vivid nightmares or night terrors?

Provide detail of the above

Describe how often they have bad dreams or night terrors.

Do you snore or have breathing difficulties during sleep?

Mention any known breathing issues during sleep. If yes to either of these things please see below and complete the questionnaire below.

Please complete the British Snoring & Sleep Apnoea Association Questionnaire by following the provided link. Once you receive your results, copy and paste the section that states your score (e.g., Your score is 3/8. You could be at risk for Obstructive Sleep Apnoea (OSA)) into the designated area.

Please use the link below complete the questionaire.

Provide Score Here

Do you experience restless legs or frequent movements during sleep?

Describe any discomfort or movement disturbances.

Please complete this sleep diary as part of the NICE guidelines, which require us to assess sleep quality and duration. You can download the sleep diary from the following website: Sleep Foundation Diary. Once completed, please up-load the sleep diary below.

Please use the link below to download diary.

Use this area to upload your sleep diary

Do you experience excessive daytime sleepiness or fatigue?

Note if you feel unusually tired during the day.

Do you struggle to wake up in the morning feeling refreshed?

Indicate if you wake up feeling well-rested or fatigued.

Section 4: Past and current medical history

Have you been diagnosed with any sleep disorders?

List any diagnosed sleep conditions.

Are you neurodivergent and/or living with mental health conditions?

Please tell us if you are neurodivergent (ADHD, ASC, or both) or awaiting a diagnosis. Please also include if you have been diagnosed with any mental health conditions.

Section 5: Prescribed medication

Are you currently taking any medications?

Please list any medications you are taking, including those prescribed or over-the-counter. Please also include frequency and dose of medication.

Have you noticed any changes in your sleep since starting any medication?

Some medications, such as corticosteroids, SSRIs, and beta-blockers, can cause sleep difficulties. Please mention any concerns related to your sleep regarding medication.

Section 6: Substance use

Does you consume any substances that may affect your sleep? This includes caffeine (e.g., tea, coffee, energy drinks), nicotine, or any other substances

Please provide details if applicable.

Section 7: Additional Information

Is there anything else you feel we should know?

Please use this space for anything you feel is relevant.