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Teen Sleep Habits Survey

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SURVEY INSTRUCTIONS MARKING INSTRUCTIONS 78
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Please answer the questions on the following pages as • Use a No. 2 pencil or a blue or black ink pen only. 76
accurately and honestly as you can. This survey is
anonymous, and there is no way to identify any individual • Do not use pens with ink that soaks through the paper. 75
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respondent. The answers will be reported only by grade • Make solid marks that fill the response completely.
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level and school. There are no right or wrong answers. • Make no stray marks on this form. 72
You can skip any question that you do not understand or
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choose not to answer. Do not spend too much time on CORRECT: INCORRECT: 70
any one answer. Your first impression is usually best.
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1. What time do you usually go to bed on school days? 9. There are many reasons for doing things at one time or
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List one time, not a range. another. What is the main reason you usually go to bed at
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this time on weekends? ( Mark only one.)
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p.m./a.m.
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My parents have set my bedtime
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2. There are many reasons for doing things at one time or I feel sleepy
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another. What is the main reason you usually go to bed at I have finished my homework
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this time on school days (Mark only one) My TV shows are over

F
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I have finished socializing (texting, phone calls, etc.)
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My parents have set my bedtime I got home from my job
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I feel sleepy Other
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I have finished my homework
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My TV shows are over 10. On weekends, after you go to bed at night, about how
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I have finished socializing (texting, phone calls, etc.) long does it usually take you to fall asleep?
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I got home from my job
Other

long does it usually take you to fall asleep?

Less than 10 minutes
10-20 minutes
More than 20 minutes
O
3. On school days, after you go to bed at night, about how
Less than 10 minutes
10-20 minutes
More than 20 minutes

11. What time do you usually wake up on weekends? List

one time, not a range.

a.m./p.m.
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4. What time do you usually wake up on school days? List 12. What is the main reason you usually wake up at this time
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one time, not a range. on weekends? (Mark only one.)
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p.m./a.m. Noises or my pets wake me up
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My alarm clock wakes me up
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5. What is the main reason you usually wake up at this My parents or other family members wake me up
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time on school days? (Mark only one) I need to go to the bathroom
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I don't know, I just wake up
PR

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Noises or my pets wake me up Other
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My alarm clock wakes me up
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My parents or other family members wake me up 13. Some people wake up during the night, others never do.
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I need to go to the bathroom How many times do you usually wake up during the night?
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I don't know, I just wake up
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Other Never
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Once
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6. What time do you usually leave home on school days? 2 or 3 times
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More than 3 times
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a.m. I have no idea
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7. How do you usually get to school? 14. People sometimes feel sleepy during the daytime. During
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your daytime activities, how much of a problem do you have
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Walk/ride a bike with sleepiness (feeling sleepy, struggling to stay awake)?
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Take the bus
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Get a ride with family member No problem at all
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Get a ride with friend(s) A little problem
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Drive my car More than a little problem
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A big problem
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8. What time do you usually go to bed on weekends? A very big problem
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p.m./a.m.
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15. How often do you nap on school days? 19. Do you consider yourself to be a:
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Never Good sleeper
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Only when I am sick Poor sleeper
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Sometimes
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Every day 20. How often do you think you get enough sleep during the
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school week?
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16. How often do you nap on weekend days?
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Never
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Never Rarely
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Only when I am sick Sometimes
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Sometimes Usually
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Every day Always
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17. How much sleep do you need? Fill out below how much 21. How often do you think you get enough sleep on the
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sleep you think you would need each night to feel your best weekend?
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every day. (Remember to mark hours and minutes, even if
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the minutes are zero.) Never
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Rarely
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hours minutes Sometimes
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Usually
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18. In general, do you feel you usually get: Always
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Too much sleep
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Enough sleep

F
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Too little sleep
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22. During the last two weeks, have you struggled to stay awake (fought sleep) or fallen asleep in the following situations?
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(Mark one answer for every item.)
52 Both struggled to
Struggled
51 No Fallen stay awake and
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In a class at school
While doing homework on the computer
Reading, studying or doing homework
While taking a test
Traveling in a bus, train, plane or car
Attending a performance (movie, concert, play)
O to stay
awake
asleep fallen asleep
O
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Watching television or listening to music
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Playing video games
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Driving a car
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In a face-to-face conversation with another person
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23. During the last two weeks, how often have you done the following? (Mark only one answer for every item.)
PR

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Once or
31 Never Several
twice a Once a day
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times a day
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Drank a beverage with caffeine (Coke, Pepsi, Monster, Mountain Dew, Red Bull)
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Drank coffee or tea with caffeine
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Used tobacco (cigarettes, cigar, chewing tobacco, etc.)
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Drank alcohol
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Used drugs
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24. In the last two weeks, how often have you done the following? (Mark one answer for every item.)
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Never Once Several Every
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Times day/night
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Arrived late to class because you overslept
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Fallen asleep in a morning class
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Fallen asleep in an afternoon class
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Awakened too early in the morning and couldn't get back to sleep
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Stayed up until 3 a.m. or later
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Slept later than noon
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Felt tired, dragged out, or sleepy during the day
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Needed to be told more than once to get up in the morning
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Had an extremely hard time falling asleep
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Had nightmares or bad dreams during the night
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Gone to bed because you could not stay awake any longer
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Done dangerous things without thinking
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Had a good night's sleep
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25. During the last two weeks, how often were you bothered or troubled by the following? (Mark one answer for every
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item.)
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Never Once Several Every 79
Twice
Times day/night 78
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Arrived late to class because you overslept
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Feeling too tired to do things
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Having trouble going to sleep or staying asleep
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Feeling unhappy, sad, or depressed
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Feeling hopeless about the future
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Feeling nervous or tense
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Worrying too much about things
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26. Ideally, when would be the best time for you for If you did not have your job, would you go to bed:
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school to start?
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Earlier than you do
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7:00 am Later than you do
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7:30 am The same as you do
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8:00 am
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8:30 am If you did not have your job, would you wake up:
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9:00 am
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Later than 9:00 a.m. Earlier than you do
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Later than you do
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27. Imagine you have to take a two-hour test, but you The same as you do
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can take it when you think you will do your best. What

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time is that? 31. During last week, did you study/do homework?
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8:00-10:00 a.m. No (Skip to question 32)
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11:00-1:00 p.m. Yes
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3:00-5:00 p.m.
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7:00-9:00 p.m. During the last week, when did you study/do
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homework? (Mark all that apply.)

your favorite things?

8:00-10:00 a.m.
11:00-1:00 p.m.
3:00-5:00 p.m.
7:00-9:00 p.m. O
28. When do you usually have the most energy to do
In the morning before school
In the afternoon after school
In the evening on days that you had school
On the weekend

How many hours do you study outside of school?

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29. When does your body start to tell you it's time for
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bed (even if you ignore it)? Between: During the school week: hours
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8:00-9:00 p.m. During the weekend: hours
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9:00-10:00 p.m.
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10:00-11:00 p.m. During the last week, did you struggle to stay awake
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11:00-12:00 a.m. (fight sleep) or fall asleep while studying?
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After 12:00 a.m.
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No
PR

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30. During last week, did you work at a job for pay? Struggled to stay awake
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Fell asleep
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No (Skip to question 31) Both struggled to stay awake and fell asleep.
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Yes
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If you did not have to study, would you go to bed:
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During the last week, when did you work? (Mark all
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that apply.) Earlier than you do
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Later than you do
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In the morning before school The same as you do
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In the afternoon after school
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In the evening on days that you had school If you did not have to study, would you wake up:
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On the weekend
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Earlier than you do
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How many hours do you work at your paying job? Later than you do
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The same as you do
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During the school week: hours 32. During last week, did you engage in organized sports
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or a regularly scheduled physical activity?
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During the weekend: hours
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No (Skip to question 33)
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During the last week, did you struggle to stay awake Yes
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(fight sleep) or fall asleep at your job?
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During the last week, when did you practice? (Mark
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No all that apply.)
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Struggled to stay awake
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Fell asleep In the morning before school
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Both struggled to stay awake and fell asleep. In the afternoon after school
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In the evening on days that you had school
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On the weekend
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How many hours do you practice? 34. Are your grades in school mostly?
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During the school week: hours A's B's and C's D's
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A's and B's C's D's and F's
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During the weekend: hours B's C's and D's F's
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During the last week, did you struggle to stay awake 35. Do you drive a car?
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(fight sleep) or fall asleep during practice?
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Yes No (Skip next question)
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No
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Struggled to stay awake 36. If yes, have you ever had an accident?
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Fell asleep
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Both struggled to stay awake and fell asleep. Yes No
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If you did not have your sports activity, would you 37. Do you have any disabilities or chronic illnesses (for
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go to bed: example, asthma, diabetes, deafness, physical impairment,
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etc.)?
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Earlier than you do
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Later than you do Yes No
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The same as you do
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38. Compared to others your age, would you say that your
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If you did not have your sports activity, would you health is:
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wake up:
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Poor Fair Good Excellent
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Earlier than you do

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Later than you do 39. Do you take medication to help with concentration or a
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The same as you do learning disability
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33. During last week, did you participate in organized Yes No
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activities (i.e., clubs, music, etc.)?
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40. During the last two weeks, how many days did you stay
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No (Skip to question 34) home from school because you were:
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Yes

(Mark all that apply.)

In the morning before school
In the afternoon after school O
During the last week, when did you participate?

In the evening on days that you had school

Sick:

Other:
0 days

0 days

Why did you stay home?

1 day

1 day

41. Do you have a TV in your bedroom?

2 days

2 days
3 days

3 days
3+ days

3+ days
O
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On the weekend
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Yes No
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Outside of regular school hours, how many hours do
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you participate? 42. Do you have a computer in your bedroom?
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During the school week: hours Yes No
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During the weekend: hours 43. Do you have a telephone/cell phone in your bedroom?
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PR

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During the last week, did you struggle to stay awake Yes No
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(fight sleep) or fall asleep during this participation?
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44. Your gender:
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No
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Struggled to stay awake Male Female
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Fell asleep
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Both struggled to stay awake and fell asleep. 45. Your age:
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If you did not have your extracurricular activity, would 13 17
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you go to bed: 14 18
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Earlier than you do 16
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Later than you do
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The same as you do 46. Your grade:
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If you did not have your extracurricular activity, would 9 10 11 12
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you wake up:
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47. What best describes your racial/ethnic background?
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Earlier than you do (Check all that apply)
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Later than you do
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The same as you do White/Caucasian Native Amercian/Pacific Islander
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Black/African American African
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Hispanic/Latino Other
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Asian/Asian American
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