Sleep Deprivation Survey
How many hours per night do you sleep on average?
Please rate yor sleeping hours
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Please rate yor sleeping habits
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How likely you fall asleep while doing the followings:
Never
Slightly
Moderately
Likely
Very Likely
Watching TV programs (movies, dramas,etc.)
Sitting & reading
sitting inactive in a public space
As a passenger in a car for an hour without a break
Lying down in the afternoon
Sitting & talking to someone
Sitting after a lunch
Driving a car, while stopped for a few minutes in traffic
What are the numbers of hours you spend per week at your clinical site or workplace?
What are the numbers of hours per week you spend studying, at lectures/meetings, etc.?
If you are experiencing sleepiness, what do you feel are the causes?
Does sleepiness affect your clinical and didactic performance?
Submit
Should be Empty: