Student survey PHYL 160 The Science of Sleep

NAME:

male female

1. How did you learn about this course? a friend at registration other (specify) school newspaper an instructor nothingness nothingness nothingness

2. Which answer best describes your academic experience. 1st semester student 3rd semester student > 4th semester 2nd semester 4th semester nothingness nothingness nothingness nothingness

3. Which answer is closest to your overall GPA. 4.0 - 3.5 2.9 - 2.5 below 2.0 3.4 - 3.0 2.0 - 2.0 nothingness nothingness nothingness nothingness

4. Did you complete a physical science course in High School? physics earth science (geology) other (specify) chemistry astronomy nothingness nothingness nothingness

5. Did you complete a life science course in High School? biology physiology other (specify) zoology biochemistry nothingness nothingness nothingness

6. Did you complete a physical science course in college? physics earth science (geology) other (specify) chemistry astronomy nothingness nothingness nothingness

7. Did you complete a life science course in college? biology physiology other (specify) zoology biochemistry nothingness nothingness nothingness

8. How many college courses are you taking this semester? more than 5 4 2 5 3 just this one nothingness nothingness nothingness

9. Do you work in addition to going to college? yes, less than 5 hrs/wk yes, 10-15 hrs/wk yes, more than 20 hrs/wk yes, 5-10 hrs/wk yes, 15-20 hrs/wk no, I am a full-time student nothingness nothingness nothingness

10. Which is closest to your age? less than 20 years old 26 - 30 years old 36 - 40 years old 21 - 25 years old 31 to 35 years old over 40 years old nothingness nothingness nothingness

11. On average, how much sleep do you get each night during the work week? < 5 hours 7 hours 9 hours 6 hours 8 hours > 10 hours nothingness nothingness nothingness

12. On average, how much sleep do you get each night on the weekends? < 5 hours 7 hours 9 hours 6 hours 8 hours > 10 hours nothingness nothingness nothingness

13. Do you consider yourself a very light sleeper moderate sleeper very heavy sleeper light sleeper heavy sleeper nothingness nothingness nothingness nothingness

14. On average, how often do you wake up during the night? more than 5 times 2 - 3 times almost never 4 - 5 times 1 - 2 times nothingness nothingness nothingness nothingness

15. On average, how long would you estimate it takes for you to fall asleep? less than 15 min. 31 - 45 min. more than 60 min. 16 - 30 min. 46 - 60 min. nothingness nothingness nothingness nothingness

16. Have you ever dozed off while driving? yes how many times nothingness no nothingness nothingness nothingness nothingness nothingness

17. Do you sleep mostly on your back left side all side front right side don't know nothingness nothingness nothingness

18. On average, what time do you go to sleep on a week night? 8:00 - 9:00 pm 10:00 - 11:00 pm 12:00 - 1:00 am 9:00 - 10:00 pm 11:00 - 12:00 pm after 1:00 am nothingness nothingness nothingness

19. If allowed to nap during the day how long would you sleep? less than 20 minutes 31 - 40 min. 51 - 60 min. 21 - 30 min. 41 - 50 min. more than 60 min. nothingness nothingness nothingness

20. When do you feel the most sleepy during the day time (7am - 7pm) 7 - 9am 11 - 1pm 3 - 5pm 9 - 11am 1 - 3pm 5 - 7pm nothingness nothingness nothingness

21. Have you ever taken a sleep aid to help you sleep? Tylenol PM Other non perscription sleep Aid Specify Ambien Other perscription sleep Aid Specify nothingness nothingness nothingness

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