Start date/time

Date

Hour

Minutes

AWAKE Check is designed to raise awareness of possible insomnia and/or sleep apnoea (breathing pauses during sleep). It’s free, confidential, anonymous, takes 5 minutes, and is not a diagnosis.

Your responses are handled by Adrian Zacher (PhD researcher, Vrije Universiteit Brussel) and research team. Data are stored securely in the UK on an encrypted, offline device in line with GDPR.
By tapping > you confirm you’re 18+, UK-based, have read the Participant Information Sheet, and give informed consent to take part. Get sleep support resources.

1. Do you snore loudly? (Loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night.)* This field is required.

Yes

2. Do you often feel tired, fatigued, or sleepy during the daytime? (Such as falling asleep during driving or talking to someone.)* This field is required.

Yes

2a. How frequently do you feel tired, fatigued, or sleepy during the daytime?This helps us understand how often this affects your daily life

Never

Rarely

Sometimes

Often

Very often

3. Which best describes your work pattern?* This field is required.

Day shifts

Night shifts

Rotating shifts

Irregular

Unemployed

Retired

4. Has anyone observed you stop breathing or choking/gasping during your sleep?* This field is required.

Yes

4a. Does someone usually share your bed who might observe your sleep (e.g., snoring, pauses in breathing)?* This field is required.

Yes

Sometimes

5. Do you have or are being treated for high blood pressure?* This field is required.

Yes

6. Are you older than 50?* This field is required.

Yes

6a. To help us understand results across different age ranges, please select your age group:* This field is required.

18 - 29

30 - 44

45 - 59

60 - 74

75 +

7. Is your shirt collar 16 inches (40 cms) or larger?* This field is required.Unsure? XL shirt collar = ‘Yes’. Otherwise tick ‘No’.

Yes

8. Is your gender male?* This field is required.

Yes

8a. How would you describe your gender?* This field is required.This helps us better understand the population completing the AWAKE Check

Female

Non-binary

Intersex

Prefer not to say

Other

Which units would you like to use?* This field is required.

Metric (cm/kg)

Imperial (ft/in, st/lb)

9. Please enter your height in FEET* This field is required.Whole numbers only (e.g. 6 foot tall) ignore the inches here

Just how many feet - no inches

9a. Please now enter any additional height in INCHES* This field is required.As in 6 foot 2 inches

10. Please enter your weight in STONES* This field is required.(As in, 12 stone ignore the lbs here)

Whole numbers of stone - no pounds

10a. Please enter the additional weight in POUNDS (lbs)* This field is required.As in 12 stone 4 lbs

Height_M_Converted

Weight_KG_Converted

9. Please enter your height in CENTIMETRES* This field is required.

9a. Please enter your weight in KILOS* This field is required.

BMI Calculatorto be hidden

10. Are you currently taking a prescribed sleep medication?* This field is required.

Yes

BMI_addto be hidden - this variable will be 1 if the BMI > or equal to 35

11. How difficult has it been for you to FALL ASLEEP?* This field is required.😖 Very severe difficulty ←——→ 🙂 No difficulty at all

12. How difficult has it been to STAY ASLEEP through the night?* This field is required.😖 Very severe difficulty ←——→ 🙂 No difficulty at all

13. How much of a problem has WAKING TOO EARLY been?* This field is required.😖 Very severe difficulty ←——→ 🙂 No difficulty at all

About your sleep symptoms

We’ll ask how long you’ve had insomnia (in months if under a year, or in years if longer) and how many nights per week you usually experience symptoms.

13a. How long have you experienced insomnia symptoms?

Less than 3 months

3 - 6 months

6-12 months

More than 1 year

How many months have you had insomnia symptoms?If less than a year: How many months have you had insomnia symptoms?

How many years have you had insomnia symptoms?If more than a year: How many years have you had insomnia symptoms?

On average, how many nights per week do you experience insomnia symptoms?Please enter a number from 0 to 7

14. How SATISFIED/DISSATISFIED are you with your current sleep pattern?* This field is required.😖 Very dissatisfied ←——→ 🙂 Very satisfied

15. To what extent do you consider your sleep problem to INTERFERE with your daily functioning?* This field is required.😖 Very much interference ←——→ 🙂 No interference at all

16. How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life?* This field is required.😖 Very noticeable ←——→ 🙂 Not noticeable at all

17. How WORRIED or DISTRESSED are you about your current sleep problem?* This field is required.😖 Very worried/distressed ←——→ 🙂 Not worried at all

18. Please enter the FIRST PART of your UK postcode* This field is required.It should be in the standard format, e.g. XX1X. We’ll only use this to group responses by UK region - your exact location is not stored or shared.

ISI_Total_Score(to be hidden - displayed at end) Your ISI score reflects how much insomnia may be affecting your sleep and daily life.

STOP_Bang_Score(to be hidden - displayed at end) Your STOP_Bang score represents your risk of sleep apnoea. Numerical passed to Category

ISI_CategoryTo be hidden - text value from numerical

ISI_Numto be hidden

STOP_Bang_CategoryTo be hidden - text value from numerical

STOP_Numto be hidden

BMI_FlagTo be hidden - text value from numerical

BMI_Numto be hidden

Composite_Scoreto be hidden

Calculate composite scorehide this

Outcome_CodeTo be hidden

19. When did you last discuss sleep problems with a healthcare professional?* This field is required.

Never

Within 6 months

6-12 months

More than a year ago

19a. Have you previously been diagnosed with Obstructive Sleep Apnoea?

YESNO

[OPTIONAL] Email you a copy of your AWAKE Check scores?Get an email copy of your numerical scores, to share with a health professional, if needed. (We will only use this to send your AWAKE Check scores and to enter you into the prize draw (if you wish)).

example@example.com

TESTING PURPOSES - HIDE ME

Height_M: {height_m_converted}

Weight_KG: {weight_kg_converted}

BMI: {bmi}

BMI ≥ 35: {bmi_add}

BMI_Num: {BMI_Num}

BMI_add: {BMI_add}

BMI_Flag: {BMI_Flag}

STOP_Bang score: {STOP_Bang_Total}

Stop_Bang category: {STOP_Bang_Category}

STOP_Num: {STOP_Num}

ISI score: {isi_total_score}

ISI Category: {ISI_Category}

ISI_Num: {ISI_Num}

Composite Score: {Composite_Score70}

Outcome_Code: {Outcome_Code}

Click SEE MY SCORES below for your AWAKE Check instant results!

Hint: Take a screenshot of your scores.

This is not a diagnosis - share your results with your pharmacist or GP to guide your next steps.

Completion date/time

Date

Hour

Minutes