Energy & Mood
1) At what time of day do you feel most energetic?
2) At what time of day do you feel down or tired? (Check all that apply)
3) Choose the answer that best describes your sleep and mood.
How I sleep (nighttime):
My energy/mood (daytime):
I get enough sleep
I don't get enough sleep
I oversleep
I feel fine during the day
I feel tired or down at some point during the day
Sleep
4) What time do you usually fall asleep?
5) How long do you usually lie awake before falling asleep?
6) When you go to bed at your usual time, what time does your body wake up naturally? (Assume that you don't use your alarm clock and you are free from work, school, or other commitments.)
7) What time do you need to get up each morning?
8) Describe how you sleep. (Assume you need to wake up at a certain time each morning.)
How I fall asleep:
My ability to stay asleep at night:
How my body naturally wakes up:
Easily
Fairly easily
A little difficult
Difficult
Very difficult
Usually stay asleep
Wake up but fall asleep again easily
Wake up but difficult to fall sleep again
Difficulty staying asleep
Much earlier than I'm supposed to
Earlier than I'm supposed to
Without problems
I need the alarm to wake me up
I still sleep in after the alarm
Very difficult to get up
Usually before the alarm, but sometimes I sleep in
9) What time of year do you notice sleep, energy or mood problems?
10) Circadian Rythm Disorders differ according to age and sex. Please specify:
Results
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