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Sleep Satisfaction Survey
The following questions will you to assess your level of sleep satisfaction. The six boxes are meant to measure degrees of satisfaction from very satisfied to very dissatisfied. It is not a measure of what is normal or even healthy but how you experience your own sleep. This makes it a personal measurement for you only.
What is your level of satisfaction with with your usual experiences in the areas below?
(Please select one answer in each row)
Very SatisfiedSatisfiedNeutralDissatisfiedVery Dissatisfied
Falling asleep
Sleeping through the night
Getting back to sleep after waking in the middle of the night
Level of energy during waking hours
Feeling of alertness during waking hours
Full Name
Company
Daytime Phone Number
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