Sleep Quality Self-Assessment Sleep Quality Self-Assessment User Details Name Date Sleep Habits & Feelings 1. On average, how many hours of sleep do you get per night? 7-9 hours 5-6 hours Less than 5 hours 2. How long does it typically take you to fall asleep? Less than 30 minutes 30-60 minutes More than 60 minutes 3. How often do you wake up during the night? 0-1 time 2-3 times 4 or more times 4. How often do you feel tired or groggy during the day? Rarely or never Sometimes (2-3 days/week) Frequently (4+ days/week) 5. Do you use screens (phone, TV, computer) within an hour of bedtime? No Yes Assess My Sleep Quality Your Sleep Quality Score Download Report (PDF)
