- What time do you go to bed on weeknights? (average)
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- What time do you go to bed on weekend nights? (average)
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- What time do you wake up on weekdays? (average)
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- What time do you wake up on weekends? (average)
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- Have your parents talked to you about the importance of getting enough sleep?
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- Have your parents helped you to set a bedtime and/or a bedtime routine
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- Do you think you would benefit from a later school start time?
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- If school started later what time would you go to bed?
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- What time of the day are you most tired
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- About how long does it take you to fall asleep on average (in minutes)?
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- How many times do you remember waking per night on average and what is the most common reason for waking up?
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- Select any of the following that you consume on a regular basis (at least once a week)
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- Are you taking any medications that may affect sleep (stimulants, antidepressants, etc.)?*
* These answers are confidential
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- Do you take any drugs for non-medical purposes? *
*These answers are confidential
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- What do you do (if anything) to help yourself fall asleep when you are experiencing insomnia?
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- Do you use devices with screens (TV, tablet, phone, computer, etc) in the last 30 minutes before lights out?
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- Does your bedtime routine (within 1 hour of sleep) usually include any of the following:
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- Have you ever been diagnosed with a sleep disorder? if yes, please specify.*
*These answers are confidential
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- Do you ever experience growing pains in your legs at night?
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- Do you snore?
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- Do you have regular incidents of sleep talking or sleep walking?
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- Rate how well you sleep
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- Rate your knowledge of caffeine (both the effects it has on the body and how much is in certain products)
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- Do you buy coffee before school (Starbucks, Dunkin' Donuts, etc.)
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- Rank the following products in order of how much caffeine they contain (from most to least, 1 being most and 10 being least)*
*It's okay to guess
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