Sleep Questionnaire

This sleep-quality questionnaire—the Sleep Condition Indicator—was developed by Colin Espie, professor of sleep medicine at the University of Oxford and a co-founder of the sleep-education app Sleepio and featured in the book The Sleep Revolution by Adrianna Huffington.

 

Consider it a helpful, science-backed tool to start a conversation with yourself, your family, and your friends, and a useful reference as you take steps to renew or sustain your relationship with sleep.

 

To start, circle the most accurate response for each question.

At the end, add up your points to get your sleep assessment, along with tips for improvement.

 

Thinking about a typical night in the last month….

 

1.      How long does it take you to fall asleep?

 

0 –15 min - 4 points

16 – 30 min - 3 points

31–45 min - 2 points

46–60 min - 1 point

>60 min - 0 points

 

2.      If you then wake up one or more times during the night, how long are you awake in total? (Add up all the time you are awake.)

 

0–15 min - 4 points

16–30 min - 3 points

31–45 min - 2 points

46–60 min - 1 point

>60 min. 0 points

 

3.      If your final wake-up time occurs before you intend to wake up, how much earlier is this?

 

I don’t wake up too early/Up to 15 min. early - 4 points

16 – 30 min. early - 3 points

31–45 min. early - 2 points

46–60 min. early - 1 point

>60 min. early - 0 points

 

4.      How many nights a week do you have a problem with your sleep?

 

0 –1 - 4 points

2 - 3 points

3 - 2 points

4 - 1 point

5–7 0 points

 

5.      How would you rate your sleep quality?

 

Very good - 4 points

Good - 3 points

Average - 2 points

Poor - 1 point

Very poor - 0 points

 

Thinking about the past month, to what extent has poor sleep….

 

6.      affected your mood, energy, or relationships?

 

Not at all - 4 points

A little - 3 points

Somewhat - 2 points

Much - 1 point

Very much - 0 points

 

7.       affected your concentration, productivity, or ability to stay awake?

 

Not at all - 4 points

A little - 3 points

Somewhat - 2 points

Much - 1 point

Very much - 0 points

 

8.      troubled you in general?

 

Not at all - 4 points

A little - 3 points

Somewhat - 2 points

Much - 1 point

Very much - 0 points

 

Finally…..

 

9.       How long have you had a problem with your sleep?

 

I don’t have a problem/<1 month - 4 points

1–2 months - 3 points

3–6 months - 2 points

7–12 months - 1 point

>1 year - 0 points

 

Now add up your total score.

 

Use the following as a guide:

0–9 - Your sleep problems seem to be severe. You should definitely try to get some help.

10 –18 - You have some sleep problems. It’s important to examine your sleep habits and see how you can make changes.

19–27 - Your sleep is in good shape, but there are still many steps you can take to make it even better.

28–36 - Your sleep is in great shape. Keep doing what you’re doing.

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This questionnaire features in our 30 Day Health Reset program.

The Foundation Health Reset is our health and lifestyle program designed to introduce some potentially life changing ideas and practices that could potentially roll back the clock and add years to your life.

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