Scribd
Upload
76 views3 pages

Pre-Survey For Sleep Hygiene

The document appears to be pre- and post-surveys for a sleep hygiene class. The pre-survey asks participants to describe their current sleep, how many hours they sleep per night, their sleep satisfaction, any sleep issues, and sleep quality. The post-survey asks what they learned from the class, how helpful it was, how it could be improved, and if anything outside their control disturbs their sleep. References are provided for the Pittsburgh Sleep Quality Index and Insomnia Severity Index measurement tools used.

Uploaded by

api-726221170
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
76 views3 pages

Pre-Survey For Sleep Hygiene

The document appears to be pre- and post-surveys for a sleep hygiene class. The pre-survey asks participants to describe their current sleep, how many hours they sleep per night, their sleep satisfaction, any sleep issues, and sleep quality. The post-survey asks what they learned from the class, how helpful it was, how it could be improved, and if anything outside their control disturbs their sleep. References are provided for the Pittsburgh Sleep Quality Index and Insomnia Severity Index measurement tools used.

Uploaded by

api-726221170
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 3

Pre-Survey for Sleep Hygiene Class

Describe your sleep in your own words: ___________________________________

How many hours do you typically sleep?


Less than 4 hrs / 4 - 6 hrs / 7 - 8 hrs / 9 hrs and more

How satisfied are you with your sleep?


Very satisfied / satisfied / neutral / dissatisfied / very dissatisfied

Please circle that applies to you.


Frequent awakening (more than once every night) / difficulty falling asleep / difficulty
staying asleep / frequent dreaming / nightmares (more than once a week)

How would you rate your overall sleep quality during the last month? (PSQI)
Very good / fairly good / neutral / fairly bad / very bad

To what extent does your sleep problem interfere with your daily life? (ISI)
Very much interfering / much / somewhat / barely / not at all interfering

How much is it noticeable to others that your sleeping problem is impairing the
quality of your life? (ISI)
Very much noticeable / much / somewhat / barely / not at all noticeable

How worried are you about your current sleep problem? (ISI)
Very much / much / somewhat / barely / not at all

What do you want to learn or achieve from sleep hygiene class?

______________________________________________________________________
Post-Survey for Sleep Hygiene Class

From what you have learned in class, what can you apply to improve your sleep?
_____________________________________________________________

Was this class helpful?


Very much / much / somewhat / barely / not at all

How was this class helpful to you? _______________________________________

How can this class be improved for next attendees? _________________________

How would you rate this class? (10 being best, 1 being worst)
10 / 9 / 8 / 7 / 6 / 5 / 4 / 3 / 2 / 1

Would you recommend this class to your peers?


Yes / No

Is there anything that is not in your control that disturbs your sleep? (e.g. staff
duty, command team, etc.) _____________________________________________
References

Shahid, A., Wilkinson, K., Marcu, S., & Shapiro, C. M. (2011a). Insomnia Severity Index

(ISI). STOP, THAT and One Hundred Other Sleep Scales, 191–193.

https://doi.org/10.1007/978-1-4419-9893-4_43

Shahid, A., Wilkinson, K., Marcu, S., & Shapiro, C. M. (2011b). Pittsburgh sleep quality

index (PSQI). STOP, THAT and One Hundred Other Sleep Scales, 67(67),

279–283. https://doi.org/10.1007/978-1-4419-9893-4_67

You might also like