Dealing With Noise: Questionnaire

Dealing With Noise: Questionnaire

Note: This questionnaire is designed to help you think about your health and coping with noise. This questionnaire is not intended to diagnose or treat any ailment, condition or disease. This questionnaire is not intended as medical advice, nor as an all-encompassing health questionnaire. This set of questions is offered in good faith. If you wish, you have the freedom to simply leave this page. It's only intended to help you think. There are no "right" or "wrong" answers.

Your Work or Home Environment

• Do you have adequate necessities? (Food, clothes, shelter, a place to rest)

• Is your home environment a comfortable temperature?

• Is your environment pleasant? For example: are there pretty colors, plants or flowers, a place where you can eat, and a bed and pillow to help you sleep?

• Is this a new environment, or have you been here for a long time?

• Is there enough clean air in your work space and living space?

• Is your work space clean, tidy and organized? How about your home? Is it clean, tidy, and organized?

• Is there any clutter or un-wanted materials in your home?

• Has your home been inspected for environmental problems such as asbestos or other chemicals, lead paint chips, poor air circulation, leaking storage tanks, or termites or other pests?

• If asbestos or lead paint chips have been found in your environment, have they been removed?

• Do you use computers and electronic devices such as iPads?  How often? 

• If you use technical devices , would you say that you use them occasionally, regularly, or very often?

• Do you take regular breaks from using the computer or technical device?

Stressors in your immediate environment

• Can you describe your immediate environment? 

• Can you describe a typical morning for you? Or could you describe a typical afternoon or evening?

• Are there things in your immediate environment that bother your senses? Note: Your five senses are sight, sound, smell, touch, and taste.

• Would you say that you feel stressed in your immediate environment?

• Do you sometimes leave your immediate environment because you feel stressed? 

• Is there a certain place where you feel stressed?

• Is there a certain day of the week you feel stressed?

• Are there many places where you feel stressed? 

• How would you rate your stress level? Would you say it is low stress, medium stress, or high stress? 

• When did these stressed-out feelings start happening? Have they occurred for a long time?

Your Mood or Symptoms

• Do you dislike certain sounds or noises? 

• Do you experience depression or sadness? How often?

• Do you experience sadness, anxiety, or change in mood? How often?

• Your mood change -- is there a certain time of day it happens? Or is there a certain place it happens?

• Have you experienced a loss recently? Have you sought comfort or relief concerning the loss?

• Do you have confusion about things or people? Does the confusion make things difficult for you?

• How do your activities affect your mood? 

• If you've been having changes in mood, how long has this been happening?

Your Health History

• Can you describe your health history?

• Is there a history in your family of any health conditions?

• Have you ever had any surgeries or operations?

• Have you taken medicine or prescription medications? 

• Have you taken dietary supplements for any health conditions? 

• Have you had trauma in your life? Have you had experiences that caused you much emotional pain or trauma?

Nervousness or Anxiety

• Do you sometimes get nervous or edgy? 

• When did this start happening?

• If you get nervous or edgy, does it seem to happen more often in certain situations or environments?

• Do you sometimes have anxiety or panic attacks?  If so, when does the anxiety or attack occur?  Does it seem to happen more often in certain situations or places?

• Are other people aware of your anxiety?

• Have you discussed your depression or anxiety with your doctor?

• Do you treat yourself well?

• Do you have some thoughts that other people just don't understand?

• Do you have feelings that other people just don't understand?

• Do you have a good friend whom you trust?  Have you spent time with that friend lately? Was it a positive experience? 

• How would you describe your mood right now? How would you describe your thoughts right now?

• Do you sometimes get angry?  If so, when does it happen?

• Do you have muscle aches or pains?

• Do you have a support network of people? Do you attend any classes or "support groups"?

• What are your favorite activities? Do you enjoy some activities? 

• Do you regularly talk with friends?

How do you treat your body? How is your general health?

• Do you eat nutritious meals and healthy snacks? Do you get enough vitamins and minerals? Do you take vitamins?

• Do you drink plenty of water? The general recommendation is to drink at least eight (8) glasses each day.

• In hotter temperatures, do you drink enough cold water to refresh your body?

• Do you exercise your body? Do you exercise your muscles, such as walking or doing sit-ups or push-ups?

• Do you eat in moderation? Or do you sometimes over-eat?

• Do you drink liquids in moderation? Or do you sometimes drink too much?

• If you drink alcohol or coffee (including instant coffee or cappuccinos or espressos), do you drink it in moderation?

• Do you avoid soft-drinks such as colas and other sugary drinks ?

• Does your body react in a bad way to some foods or drinks ?

• Are you allergic to any foods or drinks? 

• Do you sometimes get depressed?

• When was the last time you saw your doctor?

• When was the last time you had a physical exam?

Are you sensitive to certain sounds or noises?

• Would you say that you are "sensitive" to certain sounds?

• How does your body react to sounds or noises?

• Can you move away from sounds that bother you?

• If you sit or stand in a noisy area, are you able to move to a different area?

• If you are sensitive to a sound, where is the sound coming from?

• Are you able to turn off the sound? Is there a button or switch to silence or decrease the sound?

• If the sound is a person talking or working or playing music, can you migrate (move) away from the person?

• Are you able to turn off the sound? Is there a button or switch where you can turn off or turn down the sound?  

• When you hear noise, what are your thoughts about the noise?

• When you hear noise, does it affect your mood? Do you behave in a certain way when you hear noise? 

• Do you notice some sounds that other people do not seem to notice?

• Do you react to some sounds that other people do not seem to react to?

• Have you had a checkup from a medical professional regarding your reactions to sound or noise?  

• Have you tried "white noise" to block out harmful noise?  You can buy an oscillating fan for about $10 or $15. It can make a whirling noise so that you don't notice the bad noise. An oscillating fan can sort of help you "fight noise with noise". 

• Have you tried using a loud speaker system and tune the radio to a non-station? In other words, turn it to "static". This could help you not to notice the bad noise.

Balance, Dizziness, Stiffness, Breathing, Hearing

• How is your balance? Can you walk straight?

• How is your hearing? Can you hear well? Do you have any ringing inside your ears?

• Are you sensitive to some sounds? 

• If yes, what kinds of sounds are you sensitive to?

• If you experience problems with certain sounds or noises, when did they start?

• Would you say these problems with noise have been (a) rare, (b) occasional, (c) often, or (d) very often?

• Do you get dizzy? How often?

• Do you get headaches? 

• If you get headaches, can you describe them? 

• How often do you get headaches? Is there a certain time of day when they happen to you? 

• How well would you say that you breathe? 

• Are you sometimes short-of-breath? 

• Do you have trouble trying to inhale air where you live? 

• Do you have trouble trying to inhale air where you study or where you take classes?

• Would you say that you have trouble breathing?

• If you think you have breathing problems or if you think you are short-of-breath, have you taken a lung function test? It is also called a pulmonary function test. 

• Do you smoke cigarettes? 

• If you smoke cigarettes, for how long have you been smoking cigarettes?

 

Neighborhood Sounds / Neighborhood Noise

• Are there bothersome sounds or noises in your neighborhood or in your community? 

• If yes, then what kind of sound is bothering you? 

• How long has this sound been bothering you?  Has it always bothered you, or only recently?

• Is the person making the sound able to turn down the sound, or turn off the sound?

• Is the neighbor able to control the sound? Or is the sound beyond his/her control?

• How long does the sound last for? Is it a short sound or a long-lasting sound? Does the sound persist (go on for a long time)?

• Does the neighbor seem to "need" the sound?

• Do you know the neighbor personally? How long have you known the neighbor?

• Would you say that you get along with the neighbor? Would you say that you are "on good terms" with the neighbor?

• Have you spoken with the neighbor in the past? What were the results?

• How often can you hear the sound?

• Does the sound only occur rarely, like once every month? Or is the sound heard often, such as every day or every night? 

• Does the sound keep you awake at night?

• Would it help to wear earplugs or earmuffs when the sound is occurring?

• Have you tried wearing earplugs or earmuffs? 

• If you were offered a free sample of earplugs, would you take the free sample?

• Is there any "soundproofing" material you can install in your home to dampen (decrease) loud sounds?

• Are you able to install stronger windows -- such as "double-paned" windows or "soundproof" windows? 

• Has your landlord allowed you to install stronger windows, stronger wall insulation, or different doors or ceilings?

• Have you installed "soundproof" material, such as "mass loaded vinyl" (MLV) or walls or ceilings? Would your landlord allow you to install it?

• Do other people (residents or neighbors or the landlord) notice the sound?

• What are your thoughts when you hear the sound?

• Do you say anything to yourself when you hear the sound?

• When you hear the sound, would you say that you have "good" thoughts or "bad" thoughts, or maybe something in-between?  

• Does the sound prevent you from doing important things that you need to do?

• Is the activity or sound in your neighborhood controlled by a landlord or a homeowners association? 

• Are the landlord / homeowners association / security personnel aware of the issue?

• How long have the landlord / homeowners association / security personnel been aware of the issue? 

• Have you written a complaint letter?

• Have you given the complaint letter to anyone? (neighbor, roommate, landlord, friend, homeowner's association, security team?)

• Have landlord / homeowners association / security team taken effective measures to reduce the noise? 

• Are there places in the same community where it might be more quiet to live?

• Could your landlord or homeowner's association allow you to move to a nearby location where it is more quiet to live? 

• Have you talked with a lawyer, a barrister, or an attorney about the noise issue?
  

Asserting Yourself

• How would you rate your assertiveness? Are you an assertive person? 

• How would you rate your self-esteem? Do you have a high self-esteem?

• How often do you introduce yourself to another person in a friendly manner? 

• Would you describe yourself as (a) Assertive, (b) Passive, (c) Passive-Aggressive, or (d) Aggressive?

• How easy is it for you to introduce yourself to new people or make new acquaintances?

• Can you assert your thoughts, your perceptions, or your preferences in a calm manner?

• Are you comfortable speaking with another person about your preferences, in general? 

• In your neighborhood or community, what are some rights that you have?

• Have you spoken with anyone involving the rights that you have?

• Have you been able to speak to someone in a calm but assertive manner, to assert your rights? 

• Are you comfortable speaking another person about your preferences of sounds and noise?

• Are you able to approach people in a calm and friendly manner if they are making noise?

• Can you introduce yourself to neighbors in a friendly manner? 

• Have sounds or noises caused disagreements between you and someone else in your neighborhood or community? 

• If yes, have you been hurt in your relationship with the other person in your neighborhood or community? 

• Would you say that you have been respectful of the rights of the other person or persons?

Your Situation at Work, School, or Home

• Do you face a lot of pressure or stress at work?

• Do you face a lot of pressure or stress at home?

• Do you face pressures seeking a job?

• How does your work affect your health? Not much, a little, or a lot?

• Are you supervised? How would you describe your supervisor?

• Do other people at your workplace or at home feel the same pressures as you?

• How would you describe the other persons in your household?

• How well do you get along with others at work or in your household?

• If you have previously taken time off from work or school in the past, has it helped you in any way? 

• How do you deal with stress or pressure?

• Would you say that you have a lot of friends?

• Do you have a good friend whom you trust?

• If you have a good friend whom you trust, have you spent time with that friend lately? Was it a positive experience? 

Your Sleep and Rest

• How many hours do you sleep per night?

• Do you sleep well? Do you sleep soundly? 

• Do you have discomfort when you try to sleep? 

• Do you have any aches or pains when you try to sleep?

• Do you experience any insomnia (inability to sleep)? 

• How long have your sleep problems been happening?

• Have you spoken with your doctor about your sleep problem?

• Are there sounds or noises that prevent you from sleeping? Have you spoken with your doctor about it?

• If sounds or noises prevent you from sleeping, are you able to compensate? Have you tried wearing ear plugs, or using "white noise" (like an upright spinning fan) to block out the bad noise?

• Do you take any medicine to help you sleep? Does the medicine helps you to sleep?

• Do you have an adequate pillow and a mattress or sofa? 

• Is your mattress or sofa comfortable?

• Is your pillow comfortable? Or do you find that it's too soft or too hard? 

• Is your pillow large enough? Does it give you enough comfort?

• What is the temperature inside your bedroom?

• Do you take a nap during the day? If so, how long have you done this? Do you find that naps help you?

Oscillating fans: upright fans and table fans. Often called "white noise".

Your Vision and Eyesight

• Have you had any problems with vision?

• Is your vision good?

• Do you wear devices to assist with your vision? (such as eyeglasses)

• Are your eyeglasses or other visual aids comfortable? Do they fit well on you?

• Are you sensitive to light or certain visual stimuli?

• When was the last time you had an eye (vision) checkup?

Your Spiritual Life

• Do you pray? How regularly?

• Do you set aside a quiet time for yourself sometime during the day?

• Do you pray for health concerns or noise concerns?

• Do you pray with other people?

• Do you find healing through prayer?

• Do you listen to hymns to God?

• Do you find it difficult to pray or to sing hymns?

• Do you have friends who share your same faith?

• Would you say that your relationships improve your health? 

• Do you have any hurts? Do you carry your hurts with you? 

• How long would you say you have carried your hurts with you ?

Do you spend time in quiet places?

Places that might be quiet

• churches, prayer rooms, or synagogues
• libraries
• museums 
• cemeteries (memorial parks)
• quiet rooms 
• quiet offices 
• a basement
• Target stores (Target Corporation stores have a "distraction-free" policy)
• senior rest homes or nursing homes
• The woods
• lakes or ponds 
• arboretums
• The mountains, or a mountain cabin

A secluded area in the Sierra Nevada Mountains (click to enlarge)

Note: This questionnaire is designed to help you think about your health and coping with noise. This questionnaire is not intended to diagnose or treat any ailment, condition or disease. This questionnaire is not intended as medical advice, nor as an all-encompassing health questionnaire. This set of questions is offered in good faith. If you wish, you have the freedom to simply leave this page. It's only intended to help you think. There are no "right" or "wrong" answers.

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