Alluna - Healthy Sleep Matters - Healthy Sleep Questionnaire


	Chances are, you've already experienced how a sleepless night can affect your daily activities. What you may not realize is how your daily activities can affect the way you sleep. Soon you'll have some helpful tools and advice that could really help change the way you sleep. Print these pages and apply the information to your lifestyle. You'll be amazed at how a few steps can bring you a long way towards healthy sleep.

	1. Complete the Healthy Sleep Questionnaire below. 2. Read and/or Print your Personal Sleep Profile. 3. Click on "Get Your Personal Sleep Calendar" 4. Print your Personal Sleep Calendar

	* Note: Your answers to these questions will not be saved or stored. Click here to view our Privacy Statement


1. Does your wake up time sometimes change throughout the week (including weekends)?


Yes	No


2.Do you tend to go to bed at different times throughout the week (including weekends)?


Yes	No


3. Do you ever read, work, or watch TV in bed?


Yes	No


4. Does your daily routine lack a good deal of exercise?


Yes	No


5. Do you ever use any of the following? (Check all that apply)


coffee cigarettes / cigars / tobacco products	alcohol


6. Do you ever lie awake in bed, frustrated that you can't sleep or worried about your ability to sleep through the night?


Yes	No


7. Do you find that sometimes, stressful situations or worries about the future keep you awake while you're trying to sleep?


Yes	No


8. Have you ever tried a sleep aid before?


Yes	No