Quality of life measures questionnaire | ||
---|---|---|
Lifestyle factors | Question | Days per week |
Sleep quality | How many days per week do you have difficulties falling asleep? | /7 |
How many days per week do you wake up too early? | /7 | |
How many days per week do you use Hypnotic medications (sleep aids)? | /7 | |
How many days per week do you fall asleep during the day? | /7 | |
How many days per week do you feel tired upon waking up in the morning? | /7 | |
How many days per week do you snore? | /7 | |
How many days per week do you experience mid-sleep awakenings? | /7 | |
How many days per week do you experience headaches on awakening? | /7 | |
How many days per week do you experience excessive daytime sleepiness? | /7 | |
How many days per week do you experience excessive movement during sleep? | /7 | |
Total score of sleep quality out of 70 | /70 | |
Mood | How many days per week do you experience no energy to get things done? | /7 |
How many days per week do you experience sadness? | /7 | |
How many days per week do you experience worry? | /7 | |
How many days per week do you experience anger? | /7 | |
How many days per week do you experience physical pain? | /7 | |
Total score of mood status out of 35 | /35 | |
Nutrition | How many days per week do you eat fast food? | /7 |
How many days per week do you eat fish/omega 3? | /7 | |
How many days per week do you eat 4–5 servings of fruits/vegetables? | /7 | |
Total score of nutrition out of 21 | /21 | |
Physical activity | How many days per week in a normal week don’t you engage in at least 30- min pre-planned physical activity? | /7 |
Smoking behavior | Do you smoke? | |
If yes, how many cigarettes do you smoke per day? | ||
Self-rated wellness & health | How much do you rate your wellness and health out of 20; 20 being the healthiest and 0 being the unhealthiest? | /20 |