Sleep Hygiene Questionnaire

Page 1 Questions
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The Sleep Hygiene Questionnaire was created by Les A. Gellis, PhD, of Syracuse University and Kenneth Lichstein, PhD, of the University of Alabama. It was published in 2009 in Behavior Therapy.

For the following items consider only the previous month. Please state the average number of days per week (0-7) that you engaged in the following activities. Bedtime = the time you attempted to fall asleep.

1. Napped during the day. *This question is required.
2. Woke up at approximately the same time *This question is required.
3. Went to bed at approximately the same time. *This question is required.
4. Drank caffeinated beverages such as coffee, tea or soft drinks 5 to 10 hours before bedtime. *This question is required.
5. Drank caffeinated beverages such as coffee, tea or soft drinks within 5 hours of bedtime. *This question is required.
6. Drank alcohol within three hours of bedtime. *This question is required.
7. Smoked a cigarette or chewed tobacco within 2 hours of bedtime or in the middle of the night. *This question is required.
8. Engaged in exciting or emotionally upsetting activities near bedtime. *This question is required.
9. Performed activities demanding high levels of concentration near bedtime. *This question is required.
10. Exercised within 4 hours of bedtime. *This question is required.
11. Worried, planned, or thought about important matters at bedtime. *This question is required.
12. Read in bed. *This question is required.
13. Watched television in bed. *This question is required.
14. Lounged around in bed. *This question is required.
15. Worried, planned, or thought about important matters in bed. *This question is required.
16. Slept on an uncomfortable mattress. *This question is required.
17. Slept in a room with an uncomfortable nighttime temperature. *This question is required.
18. Slept in a noisy environment. *This question is required.
19. Slept in a room that was too bright. *This question is required.