Form: Sleep Hygiene Index

Sleep Hygiene Index
1 – Always
2 – Frequently
3 – Sometimes
4 – Rarely
5 – Never
¹
1
2
3
4
5
1
I take daytime naps lasting two or more hours.
2
I go to bed at different times from day to day.
3
I get out of bed at different times from day to day.
4
I exercise to the point of sweating within 1 hour of going to bed.
5
I stay in bed longer than I should two or three times a week.
6
I use alcohol, tobacco, or caffeine within 4 hours 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 the internet, or clean).
8
I go to bed feeling stressed, angry, upset, or nervous.
9
I use my bed for things other than sleeping or sex (for example: watch television, read, eat, or study).
10
I sleep on an uncomfortable bed (for example: poor mattress or pillow, too much or not enough blankets).
11
I sleep in an uncomfortable bedroom (for example: too bright, too stuffy, too hot, too cold, or too noisy).
12
I do important work before bedtime (for example: pay bills, schedule, or study).
13
I think, plan, or worry when I am in bed.