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Sleep Hygiene Index

The document is a Sleep Hygiene Index survey designed to assess various habits and behaviors that may affect sleep quality. Respondents are instructed to rate each item on a scale from 'Never' to 'Always' based on their personal experiences. The survey covers aspects such as napping, bedtime routines, use of substances, and sleep environment.

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Layla Alicea
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58 views1 page

Sleep Hygiene Index

The document is a Sleep Hygiene Index survey designed to assess various habits and behaviors that may affect sleep quality. Respondents are instructed to rate each item on a scale from 'Never' to 'Always' based on their personal experiences. The survey covers aspects such as napping, bedtime routines, use of substances, and sleep environment.

Uploaded by

Layla Alicea
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
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SLEEP HYGIENE INDEX ITEMS

Name:

Age:

Gender:

For each item identified below, circle the number


to the right that best fits your judgment of its quality.
Use the rating scale to select the quality number.

Scale
Survey Item
NEVER RARELY SOMETIMES FREQUENTLY ALWAYS
1. I take daytime naps lasting two or more
1 2 3 4 5
hours.
2. I go to bed at different times from day to
1 2 3 4 5
day.
3. I get out of bed at different times from day
1 2 3 4 5
to day.
4. I exercise to the point of sweating within 1 h
1 2 3 4 5
of going to bed.
5. I stay in bed longer than I should two or
1 2 3 4 5
three times a week.
6. I use alcohol, tobacco, or caffeine within 4 h
1 2 3 4 5
of going to bed or after going to bed.
7. I do something that may wake me up before
bedtime (for example: play video games, use 1 2 3 4 5
the internet, or clean).
8. I go to bed feeling stressed, angry, upset, or
1 2 3 4 5
nervous.
9. I use my bed for things other than sleeping
or sex (for example: watch television, read, 1 2 3 4 5
eat, or study).
10. I sleep on an uncomfortable bed (for
example: poor mattress or pillow, too much 1 2 3 4 5
or not enough blankets).
11. I sleep in an uncomfortable bedroom (for
example: too bright, too stuffy, too hot, too 1 2 3 4 5
cold, or too noisy).
12. I do important work before bedtime (for
1 2 3 4 5
example: pay bills, schedule, or study).

13. I think, plan, or worry when I am in bed. 1 2 3 4 5

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