Thank you for taking the time out to accomplish the following questionnaires.
This is being done for a
research paper aimed at looking at the impact of sleep hygiene on mental health as moderated by sleep
quality among college students.
By accomplishing the questionnaires, you agree to be part of the said study. Once again, thank you very
much and God bless.
Age 20 Gender F Year level 4th year Program BEED Pre-school
The Pittsburgh Sleep Quality Index (PSQI)
Daniel J. Buysse, Charles F. Reynolds III, Timothy H. Monk, Susan R. Berman, & David J. Kupler
Instructions: The following questions relate to your usual sleep habits during the past month only. Your
answers should indicate the most accurate reply for the majority of days and nights in the past month.
Please answer all questions.
1. During the past month, when have you usually gone to bed at night?
USUAL BED TIME ______ 5 am____
2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night?
NUMBER OF MINUTES ______30 minutes____
3. During the past month, when have you usually gotten up in the morning?
USUAL GETTING UP TIME ______11 am______
4. During the past month, how many hours of actual sleep did you get at night? (This may be different
Ŭthan the number of hours you spend in bed).
HOURS OF SLEEP PER NIGHT ______5-6______
Instructions: For each of the remaining questions, check the one best response. Please answer all
questions.
5. During the past month, how often have you Not during Less than Once or Three or
had trouble sleeping because you… the past once a twice a more times
month (0) week (1) week a week (3)
(2)
a. cannot get to sleep within 30 minutes
b. wake up in the middle of the night or
early morning
c. have to get up to use the bathroom
d. cannot breathe comfortably
e. cough or snore loudly
f. feel too cold
g. feel too hot
h. had bad dreams
i. have pain
j. Other reason(s)
_______________________________
Please describe, including how often you
have had trouble sleeping because of
this reason(s):
6. During the past month, how often have you
taken medicine (prescribe or “over the
counter”) to help you sleep?
7. During the past month, how often have you
had trouble staying awake while driving,
eating meals, or engaging in social activity?
8. During the past month, how much of a
problem has it been for you to keep up
enough enthusiasm to get things done?
9. If you have a roommate or bed partner, ask
him/her how often in the past month you
have had:
a.) loud snoring
b.) long pauses between breaths while asleep
c.) legs twitching or jerking while you sleep
d.) episodes of disorientation or confusion
during sleep
e.) other restlessness while you sleep;
Please describe
____________________________
Very Fairly Fairly Very
good (0) good (1) bad (2) bad (3)
10. During the past month, how would you rate
your sleep quality overall?
Sleep Hygiene Practices Scale
Chien-Ming Yang, Shih-Chun Lin, Shih-Chieh Hsu, & Chung-Ping Cheng
Occasionally
Never
Sometimes
Always
Rarely
Frequently
The following items are descriptions of common sleep habits, daily
life activities, and sleep environments. Please circle the number to
indicate how often the situations fit your personal experiences, with
1 indicating never and 6 indicating always.
1. Bedtime not consistent daily. 1 2 3 4 5 6
2. Get out of bed at inconsistent times. 1 2 3 4 5 6
3. Stay in bed after waking up in the morning. 1 2 3 4 5 6
4. Sleep in on weekends. 1 2 3 4 5 6
5. Napping or resting in bed for over an hour during the day. 1 2 3 4 5 6
6. Lack of exposure to outdoor light during the day. 1 2 3 4 5 6
7. Lack of regular exercise. 1 2 3 4 5 6
8. Unpleasant conversation prior to sleep. 1 2 3 4 5 6
9. Not enough time to relax prior to sleep. 1 2 3 4 5 6
10. Falling asleep with TV or music on. 1 2 3 4 5 6
11. Pondering about unresolved matters while lying in bed. 1 2 3 4 5 6
12. Check the time in the middle if the night. 1 2 3 4 5 6
13. Doing sleep-irrelevant activities in bed (e.g., watching TV, 1 2 3 4 5 6
reading, etc.).
14. Worry about not being able to fall asleep in bed. 1 2 3 4 5 6
15. Worry about night-time sleep during the day. 1 2 3 4 5 6
16. Vigorous exercise during the 2 hours prior to sleep. 1 2 3 4 5 6
17. Drinking caffeinated drinks (e.g., coffee, tea, soda) within 4 1 2 3 4 5 6
hours prior to bedtime.
18. Drinking alcohol within 2 hours prior to bedtime. 1 2 3 4 5 6
19. Consuming stimulating substances (e.g., nicotine) during the 2 1 2 3 4 5 6
hours prior to bedtime.
20. Going to bed hungry. 1 2 3 4 5 6
21. Drinking a lot during the hour prior to sleep. 1 2 3 4 5 6
22. Eating too much food during the hour prior to sleep 1 2 3 4 5 6
23. Sleep environment is either too noisy or too quiet. 1 2 3 4 5 6
24. Sleep environment is either too bright or too dark. 1 2 3 4 5 6
25. Sleep environment is either too humid or too dry. 1 2 3 4 5 6
26. Feeling too hot or too cold during sleep. 1 2 3 4 5 6
27. Poor ventilation of bedroom. 1 2 3 4 5 6
28. Uncomfortable bedding and/or pillow. 1 2 3 4 5 6
29. Too many sleep-unrelated items in bedroom. 1 2 3 4 5 6
30. Sleep is interfered by bed partner. 1 2 3 4 5 6
The BBC Well-being Scale
P. Kinderman, M. Schwannauer, E. Pontin, & S. Tai
Please check the column that applies to how happy you feel generally in most parts of your life.
Not at A little Very Extremely
all (2) much (4)
(1) (3)
1. Are you satisfied with your physical health?
2. Are you satisfied with the quality of your sleep?
3. Are you satisfied with your ability to perform your
daily living activities?
4. Are you satisfied with your ability to work?
5. Do you feel depressed or anxious?
6. Do you feel that you are able to enjoy life?
7. Do you feel you have a purpose in life?
8. Do you feel in control over your life?
9. Do you feel optimistic about the future?
10. Do you feel satisfied with yourself as a person?
11. Are you satisfied about your looks and appearance?
12. Do you feel able to live your life the way you want?
13. Are you confident in your own opinions and
beliefs?
14. Do you feel able to do the things you choose to do?
15. Do you feel able to grow and develop as a person?
16. Are you satisfied with yourself and your
achievements?
17. Are you satisfied with your personal and family
life?
18. Are you satisfied with your friendships and
personal relationships?
19. Are you comfortable about the way in which you
relate to and connect with others?
20. Are you satisfied with the intimacy in your life?
21. Do you feel able to ask someone for help with a
problem if you needed to?
22. Are you satisfied that you have enough money to
meet your needs?
23. Are you satisfied with your opportunity for exercise
and leisure activities?
24. Are you satisfied with your access to health
services?
