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  2. 2017
  3. March
  4. S
  5. Sleep Health
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Questions marked with a * are required Exit Survey
 
 
* How old are you?
 
 
 
* What is your gender?
 
Male
 
Female
 
Other
 
Prefer not to say
 
 
 
What is your height in centimetres (e.g. 165 cm)?
Height in centimetres:    
 
 
 
What is your weight in kilograms? e.g. 70 kg (Women; if you are pregnant, please give your weight the month before you became pregnant)
Weight in kilograms:    
 
 
 
What is the highest level of educational qualification you have finished?
 
Ph.D. degree
 
Postgraduate degree (MSc and MA)
 
University or college degree (Bachelor's degree)
 
Vocational education (e.g. HNC, HND, NVQ)
 
Upper secondary school qualification (e.g. Highers, A levels)
 
Lower secondary school qualification (e.g. GCSE)
 
None of the above
 
 
Have any of the conditions below disrupted your daily life?
Yes, in the last 12 months Yes, but more than 12 months ago No, never
Impaired mobility potential
Debility
Muscle inflammation
Arm aches
Leg aches
Frequent headaches
Chest heaviness
Sleep disturbances
Heavy worrying
Anxiety
Depression
 
 
Here is a list of various symptoms and illnesses. Have you had any of these symptoms or illnesses during the past 12 months? Has a doctor diagnosed or confirmed the symptoms?
Have not had it during the past 12 months Have had it, but a doctor has not confirmed it Have had it and a doctor has confirmed it
* Pneumonia
* Arthritis
* Metabolic syndrome (combination of diabetes, hypertension and obesity)
* High blood pressure (hypertension)
* Low blood pressure (hypotension)
* Chest pain (angina pectoris)
* Heart attack
* Abnormal blood cholesterol
* Fibromyalgia
* Chronic fatigue syndrome/ME
Have not had it during the past 12 months Have had it, but a doctor has not confirmed it Have had it and a doctor has confirmed it
* Diabetes (Type I)
* Diabetes (Type II)
* Disease of the thyroid gland
* Bodily disability
* Obesity
* General debility or lack of strength in the body
* Chronic backache (over at least a 3-month period)
* Alcohol dependency
 
 
 
Has your blood pressure been measured in the last 2 years?
 
Yes
 
No
 
 
 
Are you having periods?
 
I have not had period(s)
 
Menstruation is regular
 
Menstruation is irregular
 
I am currently pregnant
 
I am breastfeeding
 
I am having menopause
 
I have passed menopause
 
I prefer not to answer
 
Does NOT apply
 
 
 
Have you been diagnosed with any of the following disorders or symptoms by a psychologist or a doctor? (You can check more than one option)
 
Chronic anxiety/tension
 
Chronic depression
 
Insomnia
 
Narcolepsy (Daytime sleepiness)
 
Sleep Apnoea
 
Other sleep-related disorder (please specify)