Sleep Quality Assessment Survey

Sleep Quality Assessment Survey — Form Fields

This surveys template includes 7 fields. Evaluate sleep patterns, quality, and factors affecting rest to better understand sleep health. Free to customize and use on ZenBuild.

• On average, how many hours of sleep do you get per night? (multiple choice, required) — options: Less than 5 hours, 5–6 hours, 6–7 hours, 7–8 hours, More than 8 hours
• How would you rate the overall quality of your sleep? (rating, required)
• Which of the following sleep issues do you experience regularly? (checkboxes, optional) — options: Difficulty falling asleep, Waking up during the night, Waking up too early, Feeling unrefreshed in the morning, Snoring or sleep apnea, None — I sleep well
• How consistent is your bedtime each night? (multiple choice, required) — options: Very consistent (within 30 minutes), Somewhat consistent (within 1 hour), Varies by 1–2 hours, Highly variable
• Which factors most negatively affect your sleep? (checkboxes, optional) — options: Stress or anxiety, Screen use before bed, Caffeine or alcohol, Noise or light in the bedroom, Irregular work schedule, Physical discomfort or pain
• How rested do you typically feel when you wake up? (rating, required)
• What sleep strategies or routines have worked best for you? (long text, optional)