Question 1 of 14

What is your first name? *

Question 2 of 14

What is your date of birth? *

Question 3 of 14

How many hours do you typically sleep? *

Less than 4 hours 4-5 hours 6-7 hours 7-8 hours More than 8 hours Very irregular

Question 4 of 14

How long does it take you to fall asleep? *

I fall asleep instantly Within 30 minutes About an hour Several hours Very difficult to fall asleep

Question 5 of 14

How often do you wake up during the night? *

Once or twice a night Multiple practices No particular affinity I always wake around 3 AM

Question 6 of 14

How do you feel when you wake up? *

Energized and ready Groggy Neutral Exhausted It varies

Question 7 of 14

How well do you remember your dreams? *

Very vivid and detailed Clear Partial recall Rarely Never

Question 8 of 14

What disrupts your sleep most? *

Select all that apply

Stress Scrolling phone Noise Pain Anxiety Spiritual activity No particular affinity

Question 9 of 14

Describe your sleep environment *

Peaceful and dark TV or music on City noise With a partner Alone with some light It varies

Question 10 of 14

How satisfied are you with your sleep? (1-10) *

Question 11 of 14

Do you experience vivid images or sounds while falling asleep? *

Often Sometimes Rarely Never

Question 12 of 14

How do you feel after sleeping? *

Fully restored Partially restored Unchanged Feeling worse

Question 13 of 14

Do you have a bedtime ritual? *

Meditation Reading Prayer Scrolling phone No particular affinity Other

Question 14 of 14

Overall, how would you rate your wellbeing? (1-10) *

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Sleep Energy

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