A Cross-sectional Study on Sleep
Quality among Medical Students In A
Medical College, Kolkata
This is a descriptive study on the sleep quality among the undergraduate students.
We request that you spend 5 minutes of your time on this questionnaire and
answer the appropriate questions.
Socio-economic profile
1. Age: ___________ (in years)
2. Gender: Male __ /Female __ / Other__
3. Current residence: Hostelite __ / Day Scholar __ / PG __
4. Permanent residence: Urban__ /Rural__
5. Religion: _____________
6. Academic year: 1st Prof__ / 2nd Prof__ /Final Prof Part I__ /Final Prof Part II__
7. Any Addiction: Smoking __ / Alcohol __ / Tobacco __ / None __
8. Having more than 4 cups of tea/coffee per day: Yes __ / No __
9. Daily Screen Time: >4 hrs a day __ / <4 hrs a day __
10.Regular exercise (Outdoor games/Workout/Yoga) atleast 5 days a week:
Yes__ /No__
11.Daily water intake: <2.5L __ />2.5L__
12.Total no. of family members: ______
13.Total family monthly income: ____________________
14.Height(in cm): _________
15.Weight(in kg): _________
Sleep Quality Index
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. Put a tick(✔) mark under your appropriate
answer.
5. During the past month, how often have Not During the Past Less than once a
you had trouble sleeping because
you…
Month week
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
1. During the past month, what time have you usually gone to bed at
night? ___________________
2. During the past month, how long (in minutes) has it usually taken you to
fall asleep each night? __________
3. During the past month, what time have you usually gotten up in the
morning? ___________________
4. During the past month, how many hours of actual sleep did you get at
night? (This may be different from the number of hours you spend in
bed.) ___________________
d. Cannot breathe comfortably
e. Cough or snore loudly
f. Feel too cold
g. Feel too hot
7. During the past month,
how often have you had
trouble staying awake while
driving, eating meals,
h. Have bad dreams
i. Have pain
j. other reason(s), please
describe
6. During the past month,
how often have you taken
medicine to help you sleep
(prescribed or
“over the counter”)?
Not During Less than Once or Three or
the Past once a twice a more times
Month Week week a Week
or engaging in social
activity?
No Only a very Somewhat of A very Big
Problem at Slight a Problem Problem
All Problem
8. During the past
month, how much of
a problem has it
been for you to keep
up enough
enthusiasm to get
things done?
Very Good Fairly Good Fairly Bad Very Bad
9. During the past
month, how would you
rate your sleep
quality overall?
No Bed Partner/Roommate Partner in Partner in
Partner or in another Room same same Bed
Roommate Room but
not same
Bed
10. Do you
have a bed
partner or room
mate?
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:
