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Wonderfeelz LifStyles
Regain Original Energy
Navigation Menu
Navigation Menu
Services
Celebrity Meditation
Humming Walking
Addiction Control Therapy
Attention Training Consultation For Children
Cardio Impact
Goal Selection
Check Your Stage
Athletes
Product Evaluation
About Us
Terms and Conditions
Privacy Policy
Refund and Cancellation Policy
Contact
Journal Papers
Neuropsy Meditation – Q & A
Self Training Videos
Book Slot
My account
Checkout
Pay
Cart
Compare
Neuropsy Power Meditation
Info
Lifestyle Clinic Online
WIMS
Finance
Health Habit
WORK BALANCE
Work Style
Self Scan
My Care
Sleep
Child Toilet Training
Sleep
PLEASE RATE THE FOLLOWING QUESTIONS FOR THE LAST FOUR WEEKS
Name
*
Contact Number
*
Email Address
*
Date of Birth
*
At What Time You Go To Bed
*
Hours
Minutes
AM
PM
At What Time You Get Up ?
*
Hours
Minutes
AM
PM
1. How many minutes do you need to fall asleep?
*
Less Than 20 Minutes
21 to 40 Minutes
41 to 60 Minutes
61 to 90 Minutes (1 hour to 1.30 hours)
91 or more minutes (More than 1.30 hours)
2. How many hours do you sleep during the night?
*
7 hours or more
5 to 6 hours
4 hours
2 to 3 hours
0 to 1 hour
3. My sleep is disturbed
*
Always
Mostly
Sometimes
Seldom
Never
4. I wake up too early
*
Always
Mostly
Sometimes
Seldom
Never
5. I wake up from the slightest sound
*
Always
Mostly
Sometimes
Seldom
Never
6. I feel that I have not slept all night
*
Always
Mostly
Sometimes
Seldom
Never
7. I think a lot about my sleep
*
Always
Mostly
Sometimes
Seldom
Never
8. I am afraid to go to bed because of my disturbed sleep
*
Always
Mostly
Sometimes
Seldom
Never
9. I feel fit during the day
*
Always
Mostly
Sometimes
Seldom
Never
10. I take sleeping pills in order to get to sleep
*
Always
Mostly
Sometimes
Seldom
Never
Regensburg Insomnia Scale (RIS) - Sleep Depth (Out of 12)
Regensburg Insomnia Scale (RIS) - Sleep Quantity (Out of 12)
Regensburg Insomnia Scale (RIS) - Fearfully Focusing On Insomnia (Out of 8)
Regensburg Insomnia Scale (RIS) - Hypnotics And Day Time Functioning (Out of 8)
SUBMIT
Please do not fill in this field.