Khaya Healthtech

Sleep Health Screen

Welcome,
This is a brief questionnaire to check your sleep health, which will take less than 5 minutes. The questionnaire is specifically for people who usually work during the day (i.e. do not work night- or rotating-shifts).
Only you will be privy to your personal results, which you will receive via email. We will collate and aggregate all sleep health information for your organisation to provide them with group feedback. Please be assured that there will be no way for your employer to personally identify you or view your personal results.

To receive your sleep screening results, you will need to pay a fee of R150,00. By paying this fee, both you and your recommending GP will automatically receive a copy of your screening report via email. The report will not be sent to either party until the fee has been paid. The payment link will be presented to you upon completion of the survey.

By clicking next you confirm you have read and understood the information above and agree to complete this Sleep Health Screen as accurately as possible.

Consent Section

I consent to my information being stored in the database and used for future research.

I do not consent to my information being stored in the database and used for future research.

Full name:

Age

Your Organisation:

Password

What time do you usually go to sleep at night?

What time do you usually wake up in the morning?

This is the time that you open your eyes in the morning and stop trying to sleep - no longer sleeping, snoozing or dozing. Please enter as 24-hour time e.g. 6am is 06:00

To what extent does your sleep currently impair your daytime functioning?

For example, you might find that you are less productive, more forgetful, less creative, less able to multi-task, more moody and less able to control your emotions

Indicate on how many nights you have used prescribed medication to help you sleep during the past 6 weeks.

This does not include melatonin, supplements, CBD products or other natural remedies

Do you suffer from a sleep disorder diagnosed by a health care professional?

e.g. insomnia, apnoea, restless leg syndrome, narcolepsy

Yes

If you answered "Yes" to the previous question:

Please indicate which sleep disorder:

Do you feel your sleep disorder is well managed?

A well-managed sleep disorder is one that is being treated so that you feel your sleep and daytime function have improved.

Yes