This assessment will give you insight into the level of difficulty you experience around your sleep quality and quantity.

Please enter your email:

1. What is your first and last name?

2. Do you snore loudly when you sleep?


3. Do you feel well rested in the morning?


4. Do you feel very sleepy at certain points during the day?


5. Have you ever had an accident at work, at home or on your job because you were sleepy?


6. Do you need to take naps one or more times a week?


7. Do you feel well rested after a nap?


8. Can you usually fall asleep within 20 minutes of lying in bed?


9. Do you ever feel so wired at night that it is difficult to fall asleep?


10. Do you feel wired to that extent once a week or more?


11. Do you take a sleep aid one or more times a week?


12. Do you sometimes take a sleep aid to fall asleep?


13. Do you wake up in the middle of the night?


14. Do you have any trouble falling back asleep when you wake up?


15. Does the need to move your legs at night keep you awake, or have you been diagnosed with Restless Legs Syndrome?


16. Do you have disturbing dreams at night?


17. Do you feel that you go to bed too late?


18. Do light noises wake you up?


19. Do you find that you notice even the slightest bit of light coming into your room at night?


20. Do you have young children who wake you up?


21. Do you wake up because you experience pain somewhere in the body?