Quiz – Zzzen

Personal Information

Name

Email Address

Phone

How often do you have trouble falling asleep at night?Rarely/Never1–2 nights/week3–4 nights/week5+ nights/week

How often do you wake up during the night and struggle to fall back asleep?Rarely/Never1–2 nights/week3–4 nights/week5+ nights/week

Do you wake up feeling unrefreshed?Almost neverSometimesOftenAlmost always

How much does poor sleep affect your mood, focus, or energy during the day?Not at allA littleQuite a bitA lot

How long have you experienced sleep difficulties?<1 month1–3 months3–6 months

Have you tried improving sleep with routines, natural remedies, or therapy?Not triedTried with some benefitTried, no benefitTried repeatedly, no lasting benefit

Do behaviors like napping, caffeine, alcohol, or screens affect your sleep?RarelySometimesOftenEvery day/night

Do you rely on medication to sleep?Not at allSlightlyQuite a bitCompletely

Do you have medical conditions strongly impacting your sleep (sleep apnea, other disorders)?NoNot sureYes, somewhatYes, strongly

How willing and motivated are you to improve your sleep without medication?Not at allA littleQuite motivatedVery motivated

Calculations

Result

Hello {name-1}, thank you for taking our quiz. Based on your responses, here is what we understand and suggest:

Your sleep difficulties are mild or occasional.
Likely due to minor habits, temporary stress, or situational factors.
Lifestyle adjustments (consistent bedtime, limiting caffeine/alcohol, avoiding screens before bed) may be enough to improve sleep.
CBT-I may not be necessary at this time, but education on good sleep habits could be beneficial.

Result

Hello {name-1}, thank you for taking our quiz. Based on your responses, here is what we understand and suggest:

You experience moderate sleep difficulties affecting your daytime functioning.
Sleep problems may be linked to habits, routines, or mild insomnia patterns.
CBT-I could help by providing structured strategies such as sleep restriction, stimulus control, and cognitive restructuring.
Consistent effort and motivation could significantly improve your sleep.

Result

Hello {name-1}, thank you for taking our quiz. Based on your responses, here is what we understand and suggest:

You show persistent sleep difficulties with significant daytime impact.
Sleep problems may be chronic and self-reinforcing, with patterns of worry, disrupted routines, or prior failed attempts at improvement.
CBT-I is highly recommended, as structured behavioral and cognitive interventions are likely to provide substantial benefit.
Strong motivation and readiness to change are key for successful outcomes.

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