Sleep Habits of Varina High School Students

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Please take a few moments to fill out the following survey. Choose the answer that you feel BEST applies to you! We greatly appreciate your participation.

Which of the following best describes you? *

What is your gender? *

Male

Female

Approximately how many hours of sleep do you think students need PER night? *

3-5 hours

5-7 hours

7-9 hours

9-11 hours

How many hours, on average, do you sleep per night? *

3-5 hours

5-7 hours

7-9 hours

9-11 hours

Do extracurricular activities, homework and/or work affect your sleep habits? *

Yes

Do you fall asleep using electronic devices? *

Electronic devices can be defined as cell phones, TVs, tablets, laptops, etc.

Yes, every night

Sometimes (1-2 times per week)

Rarely (1-2 times per month)

Never

Is your sleeping environment altered in anyway? *

For example, do you adjust the temperature in your room or sleep with soothing background music?

Yes

Does everyone in your household go to sleep at the same time? *

Yes

Do you take naps? *

Never

Sometimes

Rarely

Every day

I sleep... *

Choose all that apply.

with the lights on.

with the lights off.

with the door open.

with the door closed.

in the same room with another person.

Required

My sleeping space is... *

the MOST comfortable.

EXTREMELY uncomfortable.

My sleep is disrupted by... *

Choose all that apply.

infants/younger children.

pets.

noise in my neighborhood.

persistent thoughts that keep me awake.

stress.

NOTHING :)

Required

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