This questionnaire is for a research study being done.

This is intended
for High School students or Grades 7 to 12 students, ages 13 to 18
years old. You can answer each question by checking or marking the
box or boxes that correspond to your answer/answers or by filling out
the blanks provided if necessary. May I also request to please write the
name of your School, your grade level, your age, and your parents’
occupation on the front page. You can write NONE on the blank if
presently unemployed or you can also use the term HOMEMAKER for
your Mother’s occupation. Thank you!

Name of School: _________________________________

Grade level: ________
Age: _________
Father’s Occupation: _______________________
Mother’s Occupation: _______________________

1. How many hours do you sleep at night during weekdays?

(Ilang oras ang tulog mo tuwing gabi sa mga araw na may pasok sa
paaralan?)
( ) 4 hours
( ) 5 hours
( ) 6 hours
( ) 7 hours
( ) 8 hours
( ) Others - Specify _________
2. What time do you go to bed at night?
(Anong oras ka nahihiga sa gabi?)
( ) 9;00 p.m.
( ) 10:00 p.m.
( ) 11:00 p.m.
( ) 12:00 a.m.
( ) Others – Specify _______
3. What time do you sleep at night?
(Anong oras ka natutulog sa gabi?)
( ) 9:00 p.m.
( ) 10:00 p.m.
( ) 11:00 p.m.
( ) 12:00 a.m.
( ) 1:00 a.m.
( ) Others – Specify __________
4. What time do you wake up?
Anong oras ka nagigising?
( ) 5:00 am
( ) 6:00 am
( ) 7:00 am
( ) 8:00 am
( ) 9:00 am
( ) Others – specify _______

5. Do you have nocturnal awakenings? If yes, how many times per night?
Nagigising ka ba sa gabi o madaling araw? Kung yes, ilang beses ka
nagigising?
( ) YES
a. ( ) – 1x
b. ( ) – 2x
c. ( ) Others, specify _______
( ) NO
6. Reason/reasons for having nocturnal awakenings.
Dahilan o mga dahilan kung bakit ka nagigising sa gabi o madaling
araw.
 You can check several options
( ) to urinate (para umihi)
( ) because of bad dreams (dahil sa masamang panaginip)
( ) to check cellular phone
( ) sleeping problems (paputol putol na tulog)
( ) Others: Specify ______________
7. Can you go back to sleep at once after a nocturnal awakening? If NO,
how long do you stay awake (in minutes)
Nakakatulog ka ba uli agad pag nagising ka sa gabi o madaling araw?
Kung NO, ilang minuto bago ka makatulog uli.
( ) Yes
( ) No - stays awake for ___________ minutes
8. Do you take a nap in the afternoon or anytime of the day? If YES, how
many minutes or how many hours?
Umiidlip ka ba sa hapon o sa anumang oras sa maghapon? Kung YES,
ilang minuto o ilang oras?
( ) YES – I take a nap for ______________
( ) NO
9. Do you feel sleepy during the day?
Nakakaramdam ka ba ng pagkaantok sa maghapon?
( ) Never
( ) Sometimes
( )Always
( ) Others. Specify _______________
10. Which of the following digital devices do you own? Check all
possible answers.
Alin sa mga sumusunod na digital device ang meron ka o meron sa
bahay ninyo na ginagamit mo?
( ) smartphones
( ) tablet
( ) laptop/computer
( ) television
( ) play station
( ) Others: Specify ___________
11. For entertainment and relaxation purposes, which of the
following devices do you usually use at night before going to sleep.
Check all possible answers.
Bilang libangan, aling digital device ang madalas mong gamitin sa
gabi bago matulog?
( ) smartphones
( ) tablet
( ) laptop, computer
( ) television
( ) play station
( ) Others. Specify _________________
12. How long is your screen time before going to bed? (Note: Screen
time that is not educational: Ex. Chatting with friends, watching tv,
watching youtube videos , playing computer games or browsing
facebook and internet).
Ilang oras ka gumagamit ng digital device bago ka matulog sa gabi?
(Note: paggamit na hindi pang-edukasyon)
( ) 30 minutes
( ) 1 hour
( ) 3 hours
( ) 4 hours
( ) Others. Specify _______________
13. How many hours do you allot each night for school activities and
studying ( during weekdays)?
Ilang oras ang inilalaan mo tuwing gabi para sa mga gawain sa
eskwelahan at sa
pag-aaral? (weekdays)
( ) 2 hours
( ) 3 hours
( ) 4 hours
( ) 5 hours
( ) Others. Specify __________
14. Do you have other responsibilities at home or any other things
that you are obliged to do besides studies? If yes, please answer
No.15.
May iba ka bang responsibilidad sa bahay o kahit anong bagay na
kailangan mong gawin maliban sa pag-aaral? Kung Yes, sagutin ang
tanong sa No.15.
( ) Yes
( ) No
15. What other responsibilities at home do you have or other things
that you need to do besides studies?
Ano ang iba mong responsibilidad sa bahay o mga ibang bagay na
kailangan mong gawin bukod sa pag-aaral?
( ) working student: Specify work _____________________
( ) helps in taking care of your siblings
( ) helps in household chores
( ) Others: Specify __________________
16. How often do you consider yourself being sleep-deprived (less
than 8 hours of sleep for 13-18 years old)?
Gaano kadalas sa palagay mo, na ikaw ay kulang sa tulog (kulang 8
hours)?
( ) Never
( ) Sometimes (2-3x a week)
( ) always
( ) Others. Specify _______________
17. What is the primary reason why you lack sleep (less than 8
hours)? Check all possible answers.
Ano ang pangunahing dahilan kung bakit ka kulang sa tulog (kulang 8
hours)?
( ) academic demand
a. ( ) too many assignments
b. ( ) too many lessons to study
c. ( ) many projects
( ) too much screen time (sobrang paggamit ng gadgets)
( ) peer influence (Ex. Nagpupuyat din ang mga kaibigan)
( ) insomnia/sleeping difficulties (hirap makatulog)
( ) Others. Specify _____________
18. Do you usually bond with your friends before going home? If yes,
how many hours?
Madalas ba kayong mag-bonding ng mga kaibigan mo bago umuwi?
( ) Yes. Specify ___________hours
( ) No
19. Do you have any health or medical condition (Ex. Depression,
Anxiety, Insomnia, Asthma etc) that can affect sleep? If yes, please
specify.
Mayroon ka bang sakit na puwedeng makaapekto sa iyong pagtulog?
( ) Yes, Specify _______________
( ) No
20. How many months or how many years have you been having
sleep problems?
Ilang buwan o ilang taon ka nang nagkakaroon ng problema sa
pagtulog?
( ) few months. Specify: _________months
( ) few years. Specify :___________ years
21. Does sleep deprivation affect you physically? If yes, what
physical effects do you have?
Apektado ba ang yong pisikal na pangangatawan dahil sa kakulangan
ng tulog? Kung Yes, ano ang mga epekto sayo?
( ) Yes
a. ( ) weight gain (due to frequent sitting and lack of physical
activity)
b. ( ) chronic neck and back problems (kirot sa leeg at likod0
c. ( ) sakit ng ulo
 d. ( ) Acne (Tagiyawat)
e. ( ) feeling tired/weakness
f. ( ) Others. Please specify ______________________________________
( ) No

22. Does sleep deprivation affect you mentally? If Yes, what mental
effects do you experience? Please check all possible answers.
Apektado ba ang ang iyong pag-iisip dahil sa kakulangan ng tulog?
Kung yes, ano-ano ang mga epekto na ito sa pag-iisip?
( ) Yes
a. ( ) depression
b. ( ) anxiety (pagkabalisa, poagkabahala)
c. ( ) difficulty focusing or concentrating
d. ( ) Forgetfullness (makakalimutin)
e. ( ) Mood Changes (Irritabilitry etc)
f. ( ) Others. Please specify. _________________________________
( ) No

23. Does sleep deprivation affect you emotionally? If Yes, what

emotional effects do you experience? Please check all possible
answers
Apektado ba ang ang iyong emosyon dahil sa kakulangan ng tulog?
Kung yes, ano-ano ang mga epekto na ito sa iyong emosyon?
( ) Yes
a. ( ) daytime sleepiness ( madalas na pagka-antok sa araw)
b. ( ) changes in appetite ( may pagkakataon na walang ganang
kumain)
c. ( ) mood changes/irritability (Ex. sumpungin, mainitin ang ulo
etc)
d. ( ) not motivated to work or do responsibilities (walang ganang
magtrabaho)
e. ( ) Others. Please specify ______________________________
( ) No

24. Are you aware of the advantages and benefits of having enough
sleep? (8-10 hours for 13-18 yo)
Alam mo ba ang mga pakinabang o mga benepisyo ng may sapat na
tulog (8-10 hours for 13-18 years old)
( ) Yes
 ( ) No

25. Are you aware of the different physical, mental, and emotional
effects or sequelae of sleep deprivation?
Alam mo ba ang mga epekto sa katawan, sap ag-iisip at sa emosyon
ng kakulangan sa tulog?
( ) Yes
( ) No

26. What are the things that you do to promote good sleep habits?
Please check all possible answers.
Ano ang mga ginagawa mong paraan upang magkaroon ng maayos na
sleep habits?
( ) trying to sleep earlier or trying to maintain a regular sleep
schedule
( ) trying to limit electronics before bed (Binabawasan ang oras ng
paggamit ng
smartphone o gadgets bago mahiga o matulog)
( ) exercising
( ) trying to limit or avoid napping (iniiwasang maidlid sa araw)
( ) Trying not to sleep in for too long during weekends and holidays
( ) Limiting caffeine intake (binabawasan ang pag-inom ng kape at
milk tea)
( ) placing phone elsewhere before bedtime (To avoid temptation of
browsing
anytime)
( ) Others. Please specify ____________________________

THANK YOU VERY MUCH FOR YOUR TIME!