Ostomate Sleep Survey

Trio Healthcare independent sleep survey 2023

This survey aims to assess sleep quality in those who have a stoma. Sleeping is a daily routine for all of us, and often we do not spend much time thinking about its importance. However, anecdotally we are aware that often those within the ostomate community suffer with poor sleep which in turn can have long term implications on quality of life.

Please tell us a little bit about yourself...

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* 1. What is your current age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 2. What is your gender?

Male

Female

Prefer not to say

Other (please specify)

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* 3. How long have you had your stoma?

Less than 1 year

1-2 years

2-3 years

3-4 years

4-5 years

5-6 years

6-7 years

7-8 years

8-9 years

9-10 years

10 or more years

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* 4. Are you in a relationship?

Yes

Prefer not to say

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* 5. Are you currently undergoing treatment related to your stoma?

Yes

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* 6. Are you experiencing ongoing complications related to your stoma?

Yes

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* 7. Has having a stoma impacted the following aspects of your life?

Please rank on a scale of 1-5 (1 = not at all)

	1	2	3	4	5
Intimacy	Intimacy 1	Intimacy 2	Intimacy 3	Intimacy 4	Intimacy 5
Mental health	Mental health 1	Mental health 2	Mental health 3	Mental health 4	Mental health 5
Wellbeing	Wellbeing 1	Wellbeing 2	Wellbeing 3	Wellbeing 4	Wellbeing 5
Working life	Working life 1	Working life 2	Working life 3	Working life 4	Working life 5
Family life	Family life 1	Family life 2	Family life 3	Family life 4	Family life 5
Leisure time	Leisure time 1	Leisure time 2	Leisure time 3	Leisure time 4	Leisure time 5
Exercise	Exercise 1	Exercise 2	Exercise 3	Exercise 4	Exercise 5
Sleep	Sleep 1	Sleep 2	Sleep 3	Sleep 4	Sleep 5

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* 8. Which of the below most accurately describes the overall impact of living with a stoma on your day-to-day life?

Very positive

Positive

Neutral

Negative

Very negative

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* 9. Do you have any other medical conditions that disrupt your sleep?

Yes

Not sure

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* 10. Do concerns about leaks make it difficult to for you to stay away home?

Yes

Sometimes

Please tell us a little bit about your stoma...

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* 11. What was the reason for your stoma surgery?

Bowel cancer

Baldder cancer

Cancer

Crohn's Disease

Ulcerative Colitis

Diverticulitis

IBD

Trauma

Other (please specify)

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* 12. What type of stoma do you have?

Colostomy

Ileostomy

Urostomy

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* 13. Do you have a hernia?

Yes

Now sure

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* 14. What type of stoma bag do you currently use?

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* 15. What is the make of your current stoma bag?

Other (please specify)

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* 16. How often do you change your stoma bag?

More than once a day

Once a day

Every other day

Once or twice a week

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* 17. How often do you empty your stoma bag?

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* 18. How often have you experienced a leak at night in the last four weeks?

Once

Twice

Three or more times

Five or more times

Seven or more times

Ten times or more

No leaks

Please tell us about your sleep...

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* 19. How would you describe your sleep currently?

Broken

Disturbed

Restless

Deep

Restful

Light

Peaceful

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* 20. Are you a shift worker or is your sleep schedule regular?

My sleep pattern is regular

My sleep pattern is altered

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* 21. Do you regularly have trouble falling asleep?

Yes

Sometimes

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* 22. What position do you prefer to sleep in?

On my front

On my back

On my side

Sitting up

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* 23. How many hours sleep do you get a night?

Less than 4 hours

4-6 hours

6-8 hours

More than 8 hours

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* 24. How much sleep do you think you need?

Less than 4 hours

4-6 hours

6-8 hours

More than 8 hours

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* 25. Do you feel worried or nervous about going to sleep?

Not worried or nervous

Very worried or nervouse

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 26. Do you worry about leaks at night?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 27. Do you worry your stoma bag will loosen in the night?

Not worried

Very worried

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 28. Do you worry that your stoma bag will become too full?

Not worried

Very worried

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 29. Do you worry about smell at night?

Not worried

Very worried

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 30. Do you think your stoma affects you sleep?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 31. Did you sleep better before stoma surgery?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 32. Has your sleep pattern been altered since having stoma surgery?

Yes

Not sure

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* 33. Are you waking up in the night to check your stoma bag?

Yes

Sometimes

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* 34. During an average week how many nights are you waking to check your stoma bag?

Once a week

2-3 times a week

3-4 times a week

4-5 times a week

Every night

More than five times

Not applicable

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* 35. How often do you wake to check your stoma bag at night?

Once

Twice

Three times

Four times

Five times

More than Five times

Not applicable

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* 36. Do you set an alarm to check your stoma bag during the night?

Once

Twice

Three times

Four times

Five times

More than five times

Not applicable

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* 37. During an average week how many nights are you setting an alarm to check your stoma bag?

Once

Twice

Three times

Four times

Five times

More than five times

Not applicable

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* 38. How many times do you set an alarm during the night to check your stoma bag?

Once

Twice

Three times

Four times

Five times

More than five times

Not applicable

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* 39. How often do you empty your stoma bag at night?

Once

Twice

Three times or more

Five times or more

Not applicable

Please tell us how sleep impacts your life...

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* 40. Do you suffer with sleep deprivation?

Yes

Sometimes

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* 41. Do you need to rest in the day due to lack of sleep?

Yes

Sometimes

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* 42. Do you need to sleep in the day?

Yes

Sometimes

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* 43. Do you have trouble falling asleep?

Yes

Sometimes

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* 44. Do you have trouble staying asleep?

Yes

Sometimes

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* 45. Do you take anything to help you sleep?

Yes

Sometimes

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* 46. Does lack of sleep make you feel irritable or hopeless?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 47. Does lack of sleep impact your ability to work?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 48. Have you lost interest in hobbies/activities because of lack of sleep?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 49. Do you feel your mental health is impacted by your sleep?

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 50. How has your sleep impacted the following aspects of your life?

Please rank on a scale of 1-5. (1 = not at all)

	1	2	3	4	5
Intimacy	Intimacy 1	Intimacy 2	Intimacy 3	Intimacy 4	Intimacy 5
Mental health	Mental health 1	Mental health 2	Mental health 3	Mental health 4	Mental health 5
Working life	Working life 1	Working life 2	Working life 3	Working life 4	Working life 5
Family life	Family life 1	Family life 2	Family life 3	Family life 4	Family life 5
Leisure time	Leisure time 1	Leisure time 2	Leisure time 3	Leisure time 4	Leisure time 5
Excercise	Excercise 1	Excercise 2	Excercise 3	Excercise 4	Excercise 5

Ostomate Sleep Survey

Trio Healthcare independent sleep survey 2023

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* 1. What is your current age?

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* 2. What is your gender?

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* 3. How long have you had your stoma?

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* 4. Are you in a relationship?

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* 5. Are you currently undergoing treatment related to your stoma?

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* 6. Are you experiencing ongoing complications related to your stoma?

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* 7. Has having a stoma impacted the following aspects of your life?Please rank on a scale of 1-5 (1 = not at all)

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* 8. Which of the below most accurately describes the overall impact of living with a stoma on your day-to-day life?

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* 9. Do you have any other medical conditions that disrupt your sleep?

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* 10. Do concerns about leaks make it difficult to for you to stay away home?

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* 11. What was the reason for your stoma surgery?

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* 12. What type of stoma do you have?

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* 13. Do you have a hernia?

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* 14. What type of stoma bag do you currently use?

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* 15. What is the make of your current stoma bag?

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* 16. How often do you change your stoma bag?

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* 17. How often do you empty your stoma bag?

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* 18. How often have you experienced a leak at night in the last four weeks?

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* 19. How would you describe your sleep currently?

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* 20. Are you a shift worker or is your sleep schedule regular?

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* 21. Do you regularly have trouble falling asleep?

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* 22. What position do you prefer to sleep in?

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* 23. How many hours sleep do you get a night?

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* 24. How much sleep do you think you need?

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* 25. Do you feel worried or nervous about going to sleep?

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* 26. Do you worry about leaks at night?

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* 27. Do you worry your stoma bag will loosen in the night?

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* 28. Do you worry that your stoma bag will become too full?

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* 29. Do you worry about smell at night?

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* 30. Do you think your stoma affects you sleep?

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* 31. Did you sleep better before stoma surgery?

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* 32. Has your sleep pattern been altered since having stoma surgery?

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* 33. Are you waking up in the night to check your stoma bag?

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* 34. During an average week how many nights are you waking to check your stoma bag?

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* 35. How often do you wake to check your stoma bag at night?

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* 36. Do you set an alarm to check your stoma bag during the night?

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* 37. During an average week how many nights are you setting an alarm to check your stoma bag?

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* 38. How many times do you set an alarm during the night to check your stoma bag?

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* 39. How often do you empty your stoma bag at night?

* 7. Has having a stoma impacted the following aspects of your life?

Please rank on a scale of 1-5 (1 = not at all)

* 50. How has your sleep impacted the following aspects of your life?

Please rank on a scale of 1-5. (1 = not at all)