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Questionnaire Student's Vulnerability To Insomnia I. Respondents Profile

The document is a 15 question questionnaire that asks students about their vulnerability to insomnia. It collects their profile information like grade level and age. It then asks them to indicate whether they strongly agree, agree, disagree or strongly disagree with statements related to having trouble falling asleep, staying asleep, getting sufficient sleep, experiencing racing thoughts or feeling nervous/worried in bed, and feeling tired or unrefreshed upon waking.

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Vernice Suficiencia Gementiza
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57 views1 page

Questionnaire Student's Vulnerability To Insomnia I. Respondents Profile

The document is a 15 question questionnaire that asks students about their vulnerability to insomnia. It collects their profile information like grade level and age. It then asks them to indicate whether they strongly agree, agree, disagree or strongly disagree with statements related to having trouble falling asleep, staying asleep, getting sufficient sleep, experiencing racing thoughts or feeling nervous/worried in bed, and feeling tired or unrefreshed upon waking.

Uploaded by

Vernice Suficiencia Gementiza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Questionnaire

Student’s Vulnerability to Insomnia

I. Respondents Profile
Strand: ___________ Grade Level: _____________
Age: ___________ Sex: ____________________
Civil Status: _______

II. Vulnerability to Insomnia


Direction: For each statement, please check whether you Strongly Agree, Agree,
Disagree, or Strongly Disagree.

Questionnaire on Vulnerability to Insomnia

Because of having an Insomnia Strongly Agree Agree Disagree Strongly Disagree


1. I have trouble falling asleep.
2. I have trouble staying asleep.
3. I got sufficient amount of sleep.
4. I experience racing thoughts in bed.
5. I take anything to help me sleep.
6. I feel sad, irritable and hopeless.
7. I feel nervous and worried.
8. I lie awake for half an hour or more before I fall
asleep.
9. I anticipate a problem with sleep almost every
night.
10. If I frequently wake up during the night,
I have difficulty going back to sleep.
11. I have lost interest in hobbies/activities.
12. I wake up too early in the morning.
13. I feel tired when I awake in the morning.
14. I wake up un-refreshed.
15. I have difficulty staying awake during the day.

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