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EXERCISE 1.5: Self-Assessment: Poor Sleep Habits Questionnaire The Nature of Stress 31
EXERCISE 1.6: Are You a Product of Your Culture Chapter 1 32

Please take a moment to answer these questions based on your typical behavior. If you feel your sleep quality

is compromised, consider that one or more of these factors may contribute to patterns of insomnia by affecting

your physiology, circadian rhythms, or emotional thought processing. Although there is no key to determine

your degree of insomnia, each question is based on specific factors associated with either a good night’s sleep

or the lack of it. Use each question to help you fine-tune your sleep hygiene.

1. Do you go to bed at about the same time every night?

F

YES

2. Does it take you more than 30 minutes to fall asleep once in bed?

YES

3. Do you wake up at about the same time every day?

F

YES

4. Do you drink coffee, tea, or caffeinated soda after 6 p.m.?

YES

5. Do you watch television from your bed?

F

YES

6. Do you perform cardiovascular exercise 3–5 times per week?

YES

7. Do you use your bed as your office (e.g., do homework, balance checkbook,

write letters)?

YES

8. Do you take a hot shower or bath before you go to sleep?

F

YES

9. Do you have one or more drinks of alcohol before bedtime?

YES

10. Are you engaged in intense mental activity before bed (e.g., term papers,

exams, projects, reports, finances, taxes)?

YES

11. Is your bedroom typically warm or even hot before you go to bed?

F

YES

12. Does your sleep partner snore, become restless, etc., in the night?

YES

13. Is the size and comfort level of your bed satisfactory?

F

YES

14. Do you suffer from chronic pain while laying down?

YES

15. Is your sleep environment compromised by noise, light, or pets?

F

YES

16. Do you frequently take naps during the course of a day?

YES

17. Do you take medications (e.g., decongestants, steroids, antihypertensives,

asthma medications, for depression)?

YES

18. Do you tend to suffer from depression?

F

YES

19. Do you eat a large heavy meal right before you go to bed?

YES

20. Do you use a smartphone regularly, particularly in the evening?

F

YES

© Paramount Wellness Institute. Reprinted with permission. All rights reserved.

EXERCISE 1.5: Self-Assessment: Poor Sleep Habits

Questionnaire

The Nature of Stress

31

9781284103625_CH01_Print.indd 31

12/4/15 4:20 PM

The following questions are based on various behaviors observed from individuals in society. Please answer

each question as you really behave, not how you would like to be, by circling Yes or No where appropriate.

1. I keep my smartphone on throughout the day so I won’t miss any calls.

YES

2. I use my Facebook account more often than my email account.

F

YES

3. I tend to leave the water running while brushing my teeth.

YES

4. I eat more than one meal prepared outside the house each day.

F

YES

5. During the day, I constantly check emails and text messages as they

come in.

YES

6. I drive rather than take mass transit to and from work/college regularly.

YES

7. I typically take my laptop, BlackBerry, etc. on vacation with me.

F

YES

8. I have been known to flush unused medications down the toilet.

YES

9. I get more of my news from Comedy Central (e.g., The Daily Show,

The Colbert Report) than newspapers, NPR, TV news, or online

news sites.

F

YES

10. I spend less than one hour outside each day in a natural setting.

YES

11. I regularly interact (leave comments) on Web sites I visit.

F

YES

12. I find that I rely more and more on the Internet and electronic devices

for information (e.g., Garmin GPS, Google, etc.) and less on memory

retention.

YES

13. More often than not, I Tivo my favorite TV shows and watch them at

my preference or watch episodes of my favorite shows on Hulu or other

Internet sites.

F

YES

14. I recycle all cans, bottles, newspapers, etc.

YES

15. I start to feel antsy if I cannot check my email, text messages, or Facebook

account each hour or more often.

YES

16. I spend more time playing video games or surfing the Internet inside

than outside in nature each day.

YES

17. I check my emails, tweets, Facebook updates, etc. within 10 minutes of

waking up each morning.

YES

18. I have one or more tattoos as a means of self-expression.

F

YES

19. I own more than one smartphone and I use them both at the same time

(e.g., phone calls, apps, Google).

F

YES

20. I make more than one purchase online each week.

YES

21. I dread answering the onslaught of emails each day.

F

YES

22. I get a bit of a rush or excitement when my smartphone goes off.

YES

NO

EXERCISE 1.6: Are You a Product of Your Culture?

Chapter 1

32

9781284103625_CH01_Print.indd 32

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