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Survey Templates Surveys TVU Sleep Study

TVU Sleep Study


Welcome to the survey and thankyou for taking part. The first day you are reading this is Day 1. You should come back every day until Day 8 and complete the questions for each day.





Please do not use the back button in your browser or complete a day more than once. If you have entered anything incorrectly please email me at [email protected] and I will amend your data. Please remember that once your data has been fully inputted it will be analysed anonymously and therefore your answers are completely confidential.



To access the questions each day please select the relevant day from the drop-down box below and then click the 'Next' button. For example, select '1' to begin the survey on Day 1.



What day of the survey would you like to access?

DAY 1
a sleep disorder

DAY 1
an eating disorder?

DAY 1
depression?

DAY 1
any other illness which affects your eating or sleeping habits?

DAY 1
Your age
Your gender
Your height
Your weight

DAY 1
 
1. When have you usually gone to bed?
2. How long (in minutes) has it taken you to fall asleep each night?
3. When have you usually gotten up in the morning?
4. How many hours of actual sleep did you usually get? (This may be different than the number of hours
you spend in bed)

DAY 1
During the past week, how many nights have you had trouble sleeping because you…

None
Once
Twice
Three or more
Cannot get to sleep within 30 minutes
Wake up in the middle of the night or early morning
Have to get up to use the bathroom
Cannot breathe comfortably
Cough or snore loudly
Feel too cold
Feel too hot
Have bad dreams
Have pain
Other reason(s), please describe, including how often you have had trouble sleeping because of this reason(s):
 

DAY 1

Not during the past week
Less than once
Once or twice
Three or more times
During the past week, how often have you taken medicine (prescribed or “over the counter”) to help you sleep?
During the past week, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?
During the past week, how much of a problem has it been for you to keep up enthusiasm to get things done?

Very good
Fairly good
Fairly bad
Very bad
During the past week, how would you rate your sleep quality overall?

DAY 1
The final question for today:



Thinking about my food consumption over the last week, it is important to me that the food I eat on a typical day . . .

not at all important /
a little important /
moderately important /
very important
Is easy to prepare
Contains no additives
Is low in calories
Tastes good
Contains natural ingredients
Is not expensive
Is low in fat
Is familiar
Is high in fibre and roughage
Is nutritious
not at all important /
a little important /
moderately important /
very important
Is easily available in shops and supermarkets
Is good value for money
Cheers me up
Smells nice
Can be cooked very simply
Helps me cope with stress
Helps me control my weight
Has a pleasant texture
Is packaged in an environmentally friendly way
Comes from countries I approve of politically
not at all important /
a little important /
moderately important /
very important
Is like the food I ate when I was a child
Contains a lot of vitamins and minerals
Contains no artificial ingredients
Keeps me awake/alert
Looks nice
Helps me relax
Is high in protein
Takes no time to prepare
Keeps me healthy
Is good for my skin/teeth/hair/nails etc.
not at all important /
a little important /
moderately important /
very important
Makes me feel good
Has the country of origin clearly marked
Is what I usually eat
Helps me to cope with life
Can be bought in shops close to where I live or work
Is cheap

END OF DAY 1

DAY 2

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(1)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 2

SLEEP DIARY
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

END OF DAY 2

DAY 3

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(2)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 3
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

DAY 3

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

END OF DAY 3

DAY 4

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(3)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 4
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

DAY 4

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

END OF DAY 4

DAY 5

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(4)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 5
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

DAY 5

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

END OF DAY 5

DAY 6

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(5)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 6
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

DAY 6

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

END OF DAY 6

DAY 7

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(6)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 7
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

DAY 7

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

END OF DAY 7...ONE DAY TO GO!

DAY 8

FOOD DIARY



Please enter below everything you ate and drank yesterday (except water), along with the approximate quantities and the approximate time consumed.


When entering the quantities please use whatever measurement you feel is most appropriate, for example '1 glass' or '1 pint' are acceptable quantities for drinks and '1 slice' or '1 packet' are acceptable quantities for food. 'One portion' is also acceptable, but please use your judgement to consider whether your 'portion' was smaller or larger than average and adjust the number accordingly. When entering a full meal please enter the different foods seperately.


When entering times please use the 24 hour clock and enter the nearest hour only. For example, enter '16' for 4.15pm or '17' for 4.45pm.



Please enter your food diary for yesterday here:

(7)

DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 
DESCRIPTION
QUANTITY
TIME
 
 
 
 
 
 
 
 
 
 

DAY 8
How many hours ( to the nearest hour) did you sleep last night?
How would you rate the quality of your sleep last night from 1 to 5? (1=worst quality, 5=highest quality)

DAY 8

EXERCISE DIARY



Please log below your exercise activity for the previous day, in minutes.



Please include only purposeful exercise. For example, log 90 minutes of football or 30 minutes of weight lifting, but do not log walking to lectures or walking the dog (activities that were not primarily for the purpose of exercise). If in doubt, just enter it anyway.


ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 
ACTIVITY
DURATION (minutes)
 
 
 
 
 
 
 
 
 
 

DAY 8
 
1. When have you usually gone to bed?
2. How long (in minutes) has it taken you to fall asleep each night?
3. When have you usually gotten up in the morning?
4. How many hours of actual sleep did you usually get? (This may be different than the number of hours
you spend in bed)

DAY 8
During the past week, how many nights have you had trouble sleeping because you…

None
Once
Twice
Three or more
Cannot get to sleep within 30 minutes
Wake up in the middle of the night or early morning
Have to get up to use the bathroom
Cannot breathe comfortably
Cough or snore loudly
Feel too cold
Feel too hot
Have bad dreams
Have pain
Other reason(s), please describe, including how often you have had trouble sleeping because of this reason(s):
 

DAY 8

Not during the past week
Less than once
Once or twice
Three or more times
During the past week, how often have you taken medicine (prescribed or “over the counter”) to help you sleep?
During the past week, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?
During the past week, how much of a problem has it been for you to keep up enthusiasm to get things done?

Very good
Fairly good
Fairly bad
Very bad
During the past week, how would you rate your sleep quality overall?

DAY 8
The final question for today:



Thinking about my food consumption over the last week, it is important to me that the food I eat on a typical day . . .

not at all important /
a little important /
moderately important /
very important
Is easy to prepare
Contains no additives
Is low in calories
Tastes good
Contains natural ingredients
Is not expensive
Is low in fat
Is familiar
Is high in fibre and roughage
Is nutritious
not at all important /
a little important /
moderately important /
very important
Is easily available in shops and supermarkets
Is good value for money
Cheers me up
Smells nice
Can be cooked very simply
Helps me cope with stress
Helps me control my weight
Has a pleasant texture
Is packaged in an environmentally friendly way
Comes from countries I approve of politically
not at all important /
a little important /
moderately important /
very important
Is like the food I ate when I was a child
Contains a lot of vitamins and minerals
Contains no artificial ingredients
Keeps me awake/alert
Looks nice
Helps me relax
Is high in protein
Takes no time to prepare
Keeps me healthy
Is good for my skin/teeth/hair/nails etc.
not at all important /
a little important /
moderately important /
very important
Makes me feel good
Has the country of origin clearly marked
Is what I usually eat
Helps me to cope with life
Can be bought in shops close to where I live or work
Is cheap

DAY 8

END OF QUESTIONS

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