TITLE: Sleeping Pattern and Academic Performance of Science, Technology,
and Engineering Students of Llanera National High School:
A Correlational Study
The purpose of the study is to determine the relationship of sleeping pattern to
Academic Performance of Science, Technology, and Engineering (STE) students of
Llanera National High School. This questionnaire asks about your sleeping pattern in
terms of sleep quality, sleep duration, and sleep disorder. Your responses will be
anonymous and will never be linked to you personally. Your participation is entirely
voluntary. If there are items you do not feel comfortable answering, please skip them.
Thank you for your cooperation.
NAME (Optional) :_________________________
GENDER:__________
AGE:__________ GRADE
LEVEL:_______________
PITTSBURGH SLEEP QUALITY INDEX
_____________________________________________________________________
INSTRUCTIONS:
The following questions relate to your usual sleep habits during the past month only.
Your answers should indicate the most accurate reply for the majority of days and
nights in the past month. Please answer all questions.
_____________________________________________________________________
1. During the past month, what time have you usually gone to bed at night?
BED TIME __________
2. During the past month, how long (in minutes) has it usually taken you fall
asleep each night?
NUMBER OF MINUTES __________
3. During the past month, what time have you usually gotten up in the morning?
GETTING UP TIME __________
4. During the past month, how many hours of actual sleep did you get at night?
(This may be different than the number of hours you spent in bed.)
HOURS OF SLEEP PER NIGHT __________
For each of the remaining questions, check the one best response. Please
answer all questions.
5. During the past month, how often have you had trouble sleeping because…
a) Cannot get to sleep within 30 minutes
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
b) Wake up in the middle of the night or early morning
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
c) Have to get up to use the bathroom
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
d) Cannot breath comfortably
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
e) Cough or snore loudly
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
f) Feel too cold
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
g) Feel too hot
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
h) Had bad dreams
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
i) Have pain
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
j) Other reason(s), please describe __________________________________
How often during the past month have you had trouble sleeping because of this?
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
6. During the past month, how would you rate your sleep quality overall?
Very good _____
Fairly good_____
Fairly bad _____
Very bad_____
7. During the past month, how often have you taken medicine to help you sleep
(prescribed or “over the counter”)?
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
8. During the past month, how often have you had trouble staying awake while
driving, eating meals, or engaging in social activity?
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
9. During the past month, how much of a problem has it been for you to keep
enough enthusiasm to get things done?
No problem at all _____
Only a very slight problem _____
Somewhat a problem _____
A very big problem _____
10. Do you have a bed partner or room mate?
No bed partner or room mate _____
Partner/room mate in other room _____
Partner in the same room, but not same bed _____
Partner in same bed _____
If you have a room mate or bed partner, ask him/her how often in the past month you
have had…
a) Loud snoring
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
b) Long pauses between breaths while asleep
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
c) Legs twitching or jerking while you sleep
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
d) Episodes of disorientation or confusion during sleep
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
e) Other restlessness while you sleep; please describe
______________________
_______________________________________________________________
Not during the past month _____
Less than once a week _____
Once or twice a week _____
Three or more times a week _____
Direction: Put a check on the General Weighted Average (GWA) you attain
during your 1st quarter of School Year 2023-2024.
Academic 5 4 3 2 1
performance (96-100) (91-95) (86-90) (81-85) (75-80)
General
Weighted
Average
during 1st
quarter of
School Year
2023-2024.
