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:
Rows
Never
Slightly
Moderately
Likely
Very Likely
Watching TV programs (movies, dramas,etc.)
1
2
3
4
5
Sitting & reading
6
7
8
9
10
sitting inactive in a public space
11
12
13
14
15
As a passenger in a car for an hour without a break
16
17
18
19
20
Lying down in the afternoon
21
22
23
24
25
Sitting & talking to someone
26
27
28
29
30
Sitting after a lunch
31
32
33
34
35
Driving a car, while stopped for a few minutes in traffic
36
37
38
39
40
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: