Sleep Assessment

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Sleepful is designed to help people with symptoms of chronic insomnia. To make sure that Sleepful is suitable for you, please complete the brief questionnaire below. On completion of the assessment, we will provide feedback on your symptoms and offer advice on whether Sleepful seems appropriate for your sleep difficulties now. Your responses are not stored. Please see the Disclaimer and the Privacy Statement on our Legal Information page. For the origin of this assessment, please see the Sleepful: Research Evidence page.

Sleep Assessment
years
ft in
st lbs
cm
kg

This is a measure of your neck circumference - over your Adam's apple; if you don't have a tape measure, place a ribbon or tie around your neck circumference and then measure the length using a ruler or other straight measure.

cm

Loud enough to be heard through closed doors or loud enough for your bed-partner to ‘elbow’ you for snoring at night.

Tired or sleepy enough to fall asleep when driving or when talking to someone.

Over the past 2 weeks how would you rate the severity of your insomnia problems (use the scale below):

Difficulty falling asleep:
No problem Mild Moderate Severe Very Severe
1 2 3 4 5
Difficulty staying asleep:
No problem Mild Moderate Severe Very Severe
1 2 3 4 5
Problems waking up too early:
No problem Mild Moderate Severe Very Severe
1 2 3 4 5
How satisfied/dissatisfied are you with your current sleep pattern:
Very satisfied Satisfied Moderately satisfied Dissatisfied Very dissatisfied
1 2 3 4 5
How noticeable to others do you think your sleep problem is in terms of impairing the quality of your life?
Not at all noticeable A little noticeable Somewhat noticeable Much noticeable Very much noticeable
1 2 3 4 5
How worried/distressed are you about your current sleep problem?
Not at all worried A little worried Somewhat worried Much worried Very much worried
1 2 3 4 5
To what extent do you consider your sleep problem to interfere with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/home, concentration, memory, etc) currently?
Not at all interfering A little interfering Somewhat interfering Much interfering Very much interfering
1 2 3 4 5

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