Insomnia Survey

Many thanks for taking the time to take part in our survey.  We are writing a practical guide book for individuals who have insomnia.  Our focus is on helping sufferers to gain clear information about the condition and also to look at what may help them. We want to include in our book real life case studies and tips from others who have insomnia. 

 

At the end of the questionnaire is a form to fill in giving consent for use to use your information in the book, which will be published by Forward Press in 2009  You may choose for us to use a made up name if you prefer to remain anonymous. 

 

Please fill in the survey with as much detail as possible. Once again thank you for taking the time to complete this survey, your experiences will be valuable to other sufferers.

 

Kind Regards,

Victoria Dawson and Antonia Chitty

 

Life With Insomnia

 

1.       Are you Male/Female

 

2.       How old are you?

 

3.       How old were you when you started to suffer with insomnia?

 

4.       What are the characteristics of your insomnia?  Is it trouble falling asleep?  Or waking in the middle of the night etc.  Please describe in as much detail as possible. 

 

 

5.       Do you know what has caused your insomnia?  If so please give details

 

 

 

 

6.       Have you been diagnosed as having Insomnia?  If so how was it diagnosed?

 

 

7.       Has a diagnosis helped in any way?

 

 

8.       Have you been prescribed any medication for your insomnia?  If so what and did this help?

 

 

9.       Would you consider taking medication for your insomnia?

 

 

10.   Have you used any complimentary therapies to try to overcome insomnia such as aromatherapy, reiki, homeopathy? If so did any of these work?

 

 

11.   How does your insomnia affect the rest of the household?

 

 

12.   How does it make you feel when you can’t sleep?

 

 

13.   What are the worst things about insomnia?

 

 

14.   Are there any positives about insomnia?

 

 

15.   What is the best piece of advice you have been given for managing insomnia?

 

 

16.   What is the best tip you could give to others who are suffering from insomnia?

 

 

17.   Have you used any support groups? If so have these helped?

 

 

18.   Do you know of any useful organisations to support insomniacs that others may find helpful?  If so please provide details. 

 

 

 

 

 

 

 

 

Thanks you for filling in your answers. Please answer the last few questions about how we use the information you have shared with us:

 

1. Are you happy for us to use your quotes in the ‘looking after your relationship’ book:                               

Yes /No

 

2. If we use your case study, would you prefer we use a pseudonym (a made up name) OR just your first name.  Just indicate which you’d prefer:

 

I am happy for you to use my first

OR

I would like you to make up a name for me

 

 

3. You may / may not contact me again for further information.

 

Preferred method of contact: Email/Phone/Post

Please provide contact details:

 

 

 

Many thanks, Antonia and Vicki

 

Return this questionnaire by email to vickidawson@hotmail.co.uk, antonia@acpr.co.uk  or by post to 7a Channel View, Bexhill, TN40 1JT.