Sleep quality and study - 问卷调查调研模板

Q1:1.female/male

Female

Male

Q2:2.Have ever you experienced sleep problem ?

Yes

No

Q3:3.How many sleep hours do you usually get?

more than 8 hours

7-8 hours

6-7 hours

5-6 hours

less than 5 hours

Q4:4.Do you satisfy with your sleep quality?

strongly satisfied

satisfied

feel nothing for it

not satisfied

strongly not satisfied

Q5:5.How many sleep hours do you think will be enough to provide energy for the whole day?

more than 8 hours

7-8 hours

6-7 hours

5-6 hours

less than 5 hours

Q6:6.Do you have regular bedtime schedule?

Yes

No

Q7:7.When do you usually go to bed?

选项1

Q8:7.What’s the main factors that lead to your irregular bedtime?(multiple )

heavy school work

too much daytime sleep

irregular school timetable( school timetable differs everyday)

electronic games（computer、iPad）

social networking(wechat Facebook weibo etc.)

E-books reading

others

Q9:8.Do you do any sports besides P.E lesson?

Yes

No

Q10:9.Do you agree that you will have a better sleep quality after sports in day time?

strongly agree

agree

neither agree nor disagree

disagree

strongly disagree

Q11:10.Do you think that you have Wechat(Facebook or Weibo) dependence?(Can’t help to check it frequently or whenever you have time)（5 stands for strongly dependent and 1 stands for not dependent at all)

5

4

3

2

1

Q12:11.Do you use your phone after 23:00?

Yes

No

Q13:What do you use it for?( Multiple choice)

Wechat/Weibo ect.

Learining

Reading News

make phone call

Phone games

E-books reading

Q14:12.Which is your main factor that lead to a poor sleep quality(late bedtime)?

Great pressure from study

Great pressure from social life（school community, relationship )

Physical reason

Different bedtime schedule with your roommates(noise from the stay-up persons )

Indulge in computer games

Busy social networking (wechat, Weibo or others)

others

Q15:13.Do you feel sleepy when attending morning classes?(5 stands for always and 1 stands for never)

5

4

3

2

1

Q16:14.Do you feel it hard to concentrate in class if you don’t sleep well last night?(5 stands for strongly agree and 1 stands for strongly disagree)

5

4

3

2

1

Q17:15.Do you believe that a good sleep will help you improve your study efficiency?

strongly agree

agree

neither agree nor disagree

disagree

strongly disagree

Q18:16.Will you willing to make some effort to improve your sleep quality?

Yes

No

Q19:Which way will be most effective to improve your sleep quality?

stay away from social networking after 11p.m

stop playing computer games after 11p.m

plan a bedtime schedule with my roommates

medication

do some sports in the day time

others