Sleep Deprivation and School Questionnaire

Sleep Deprivation and School Questionnaire Important Information:  Please pick all answers that apply to you  If  no answer applies, please pick other and write down d own your answer  Please answer all questions honestly, your identity will not be revealed  The only people who will read these surveys will be me, and my instructor  Please answer every single question, a blank answer will void you f rom rom the research  Only put down your email if you would like to receive the results of the survey Name (optional): ______________________________________________________ (optional): ______________________________________________________ Grade:10_____ Grade:10_____ 11_____ 12_____ 13_____ Gender: Male_____ Female_____ Area of Residence (ex. Calgary, AB): _______________________________________ AB): _______________________________________ E-mail: _______________________________________________________________

1)

How many hours of  sleep

do you get on a school night? 1-3_____4-6_____7-9_____More then 9(please state)_____

2)

How many hours of  sleep do you get

3)

Have

you ever stayed up all night on a school night? Y_____N_____

4)

Have

on a non-school night? 1-3_____4-6_____7-9_____More then 9(please state)_____

you ever stayed up all night on a non-school night? Y_____N_____

5) Do you suff er er f rom rom a sleeping disorder that causes you to stay up? Y_____ N_____ 6)

If  you answered yes to 3 or 4, what were you doing all night? Homework_____Studying_____Gaming_____Other______________________________

 ___________ 7)

If  you answered yes to question 5, have you ever

taken prescription drugs to help you

get to sleep? Y_____ N_____ 8) What is your current average in school? 0%-20%_____ 21%-40%_____ 41%-60%_____ 61%-80%_____ 81%-100%_____

9) Do you of ten ten struggle with test taking? Y_____ N_____ 10) Have you ever stayed up all night the night be f ore ore a test? Y_____N_____ 11) If  yes, what were you doing? Homework_____Studying_____Gaming_____ Other_________________________________________ 12) How did you do on the test af ter ter staying up all night? 0%-25%_____26%-50%_____51%-75%_____76%-100%_____

13) How do you physically f eel eel af ter ter staying up all night?  ________________________________________________________________________  ________________________________________________________________________  ________________________________________________________________________

14) How do you mentally f eel eel af ter ter staying up all night?  ________________________________________________________________________  ________________________________________________________________________  ________________________________________________________________________

15) Would you consider yourself  to be unmotivated af ter ter staying up all night? Y_____N_____

16) What strategies do you use to stay awake the next day? (i.e. Drugs, music, etc.)  ________________________________________________________________________  ________________________________________________________________________  ________________________________________________________________________ Any other information you find important about your sleep habits:

 ______________________________________________________________________________  ______________________________________________________________________________  ______________________________________________________________________________  ______________________________________________________________________________  ______________________________________________________________________________  ______________________________________________________________________________  ______________________________________________________________________________  ______________________________________________________________________________ Thank

you f or or taking the time to answer this survey