What keeps you awake at night? (select up to top three)
Money worries
Mental health issues
Physical health issues
Relationship issues
Family concerns
Bad bed/pillows
Noise
Medication
Environment not conducive to good sleep
Not applicable
What action do you take to help you sleep better? (please select your top three)
Exercise
Sleeping pills
Other medication
Comfortable
Food
Special drinks (chai, hot chocolate, warm milk, other)
Sex
Not applicable
Other
Please Specify:
How well do you wake in the morning?
Good mood
Neutral mood
Poor mood
Feeling fresh
Felling poorly
Other
Please Specify:
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