Personal Tuning for Fibromyalgia and Migraines

Chronic Fatigue Calm Down Challenge Sleep & Anxiety Questionnaire - Day 13

You answered these questions below on anxiety, overwhelm, or sleeping problems on Day 1.

Please answer them again now, with how you are feeling now, and in the last week.

Please rate in this questionnaire:

In the last 1 week

0 = Never / Not at all

1 = rarely / very mildly / 0-1 days this last week

2 = sometimes / mildly / 2 - 3 days this last week

3 = Often / moderately / 4 -5 days this last week

4 = Almost always / severely / 6-7 days this last week

Don't forget to click submit at the bottom

Name:

Email:

Worry & Anxiety

I feel nervous or anxious

I cannot calm down and feel my thoughts spiralling out of control:

I feel restless or fidgety or cannot sit still

I experience panic and/or anxiety attacks

I have trouble relaxing

I worry about different things

I take pharmaceutical anxiolytic medications to help me relax

I take herbal and/or nutritional anxiolytic medications to help me relax

I become easily annoyed or irritable

I feel afraid that something awful might happen to me or my loved ones

Getting to sleep
In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

I have trouble falling asleep

I drink alcohol to help me get to sleep

I read, watch TV, or do things on my smart phone/digital device for more than 1 hour while in bed, before falling asleep

I take pharmaceutical sleeping medications to help me get to sleep

I take herbal and/or nutritional sleeping medications to help me get to sleep

I have restless legs and/or cannot keep my legs still when I am trying to get to sleep

I experience a creeping-crawling feeling or tingling in my legs when trying to get to sleep

I experience an inability to move when I am falling asleep or just awakening

I am generally more alert in the afternoons and evenings than in the morning

Thoughts start racing through my mind when I am trying to fall asleep

Staying Asleep

In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

I wake more than 1 time during the night

When I awaken during the night I struggle to get back to sleep

I awaken very early in the morning and cannot get back to sleep

I sleep-walk or move around in my sleep

I have been told I jerk my legs and kick in my sleep

I dream vividly and/or have nightmares

I talk or shout in my sleep

Chronic pain interferes with my sleep

I grind my teeth in my sleep

I have to wake more than 1 time per night to urinate

Overall Quality & Quantity of Sleep

In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

I awaken feeling unrefreshed or tired

I typically sleep for less than 7 hours per night

I do not go to bed and/or awaken at a regular time every day

I have been told I snore when I sleep and/or have woken myself up with my snoring

I awaken at night gasping for air and/or stop breathing whilst I sleep

I sweat a great deal at night

I awaken with headaches

I feel drowsy during the day

I take naps during the day

I perform poorly at work due to lack of sleep and/or drowsiness

Chronic Fatigue Calm Down Challenge Day 13

Worry & Anxiety

Getting to sleep
In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

Staying Asleep

In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

Overall Quality & Quantity of Sleep

In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

Don't forget to click submit below! Thanks for filling out this questionnaire

Chronic Fatigue Calm Down Challenge Day 13

Worry & Anxiety

Getting to sleepIn the last 1 week:0 = Never / Not at all1 = rarely / very mildly / 0-1 days this last week2 = sometimes / mildly / 2 - 3 days this last week3 = Often / moderately / 4 -5 days this last week4 = Almost always / severely / 6-7 days this last week

Staying Asleep

In the last 1 week:0 = Never / Not at all1 = rarely / very mildly / 0-1 days this last week2 = sometimes / mildly / 2 - 3 days this last week3 = Often / moderately / 4 -5 days this last week4 = Almost always / severely / 6-7 days this last week

Overall Quality & Quantity of Sleep

In the last 1 week:0 = Never / Not at all1 = rarely / very mildly / 0-1 days this last week2 = sometimes / mildly / 2 - 3 days this last week3 = Often / moderately / 4 -5 days this last week4 = Almost always / severely / 6-7 days this last week

Don't forget to click submit below! Thanks for filling out this questionnaire

Getting to sleep
In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week

In the last 1 week:
0 = Never / Not at all
1 = rarely / very mildly / 0-1 days this last week
2 = sometimes / mildly / 2 - 3 days this last week
3 = Often / moderately / 4 -5 days this last week
4 = Almost always / severely / 6-7 days this last week