Circadian Rhythm Test

This test is designed to help assess whether you have a circadian rhythm problem, the severity of the condition, and customize a schedule to shift your circadian rhythm back to its normal pattern. You may feel that some questions have more than one acceptable answer. Please choose the answer that is closest to your situation.

Energy & Mood


1) At what time of day do you feel most energetic?
Morning
Mid-morning
Afternoon
Late afternoon
Evening
Night
Late night (after midnight)
My energy level stays about the same during the day
I lack energy or feel down most of the day
2) At what time of day do you feel down or tired? (Check all that apply)
Morning
Mid-morning
Afternoon
Late afternoon
Evening
Night
Late night (after midnight)
I feel tired most of the time
I don't notice any specific time
3) Choose the answer that best describes your sleep and mood
How I sleep (nighttime) My energy/mood (daytime)

Sleep


4) What time do you usually fall asleep?
Before 8 pm
Before 9 pm
Before 10 pm
Before 11 pm
Before 12 am
After midnight
Rarely fall asleep
5) How long do you usually lie awake before falling asleep?
Fall asleep quickly
30 min.
Less than 1 hr.
Less than 2 hrs.
Less than 3 hrs.
Less than 4 hrs.
4 hrs. or more
Rarely fall asleep
6) When you go to bed at your usual time, what time does your body wake up naturally? (Assume that you don't use your alarm clock and you are free from work, school, or other commitments.)
2:00 AM or earlier
3:00 AM
4:00 AM
5:00 AM
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00PM
4:00PM
7) What time do you need to get up each morning?
5:00 AM or earlier
5:30 AM
6:00 AM
6:30 AM
7:00 AM
7:30 AM
8:00 AM
8:30 AM
9:00 AM
9:30 AM
10:00 AM
10:30 AM or later
8) Describe how you sleep. (Assume you need to wake up at a certain time each morning.)
How I fall asleep: My ability to stay asleep at night: How my body naturally wakes up:
9) What time of year do you notice sleep, energy or mood problems?
Begins:
Early Fall (Aug/Sep)
Late Fall (Oct/Nov)
Winter (Dec/Jan)
Late Winter (Feb)
Early Spring (Mar/Apr)
Spring/Summer (May/Jun)
Summer (Jul/Aug)
Ends:
Early Fall (Aug/Sep)
Late Fall (Oct/Nov)
Winter (Dec/Jan)
Late Winter (Feb)
Early Spring (Mar/Apr)
Spring/Summer (May/Jun)
Summer (Jul/Aug)

My problem(s) are about the same all year round
I don't notice problems at any time during the year
10) Circadian Rhythm Disorders differ according to age and sex. Please specify:
Age: Sex: Female Male

Results


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