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Sleep timing questionnaire

Sleep timing questionnaire
Please think of a GOOD NIGHT TIME as the time at which you are finally in bed and trying to fall asleep
On the night before a work day or school day, what is your earliest GOOD NIGHT TIME? ____:____ PM/AM
On the night before a work day or a school day, what is your latest GOOD NIGHT TIME? ____:____ PM/AM
On the night before a work day or school day, what is your usual GOOD NIGHT TIME? ____:____ PM/AM
How stable (ie, similar each night) are your GOOD NIGHT TIMES before a work day or school day? (circle one) 0-15 m 16-30 m 31-45 m 46-60 m
61-75 m 76-90 m 91-105 m 106-120 m
2-3 h 3-4 h >4 h  
On a night before a day off (eg, a weekend), what is your earliest GOOD NIGHT TIME? ____:____ PM/AM
On a night before a day off (eg, a weekend), what is your latest GOOD NIGHT TIME? ____:____ PM/AM
On a night before a day off (eg, a weekend), what is your usual GOOD NIGHT TIME? ____:____ PM/AM
How stable (ie, similar each night) are your GOOD NIGHT TIMES on a night before a day off (eg, a weekend)? (circle one) 0-15 m 16-30 m 31-45 m 46-60 m
61-75 m 76-90 m 91-105 m 106-120 m
2-3 h 3-4 h >4 h  
Please think of GOOD MORNING TIME as the time at which you finally get out of bed and start your day
Before a work day or school day, what is your earliest GOOD MORNING TIME? ____:____ PM/AM
Before a work day or a school day, what is your latest GOOD MORNING TIME? ____:____ PM/AM
Before a work day or school day, what is your usual GOOD MORNING TIME? ____:____ PM/AM
How stable (ie, similar each night) are your GOOD MORNING TIMES before a work day or school day? (circle one) 0-15 m 16-30 m 31-45 m 46-60 m
61-75 m 76-90 m 91-105 m 106-120 m
2-3 h 3-4 h >4 h  
Before a day off (eg, a weekend), what is your earliest GOOD MORNING TIME? ____:____ PM/AM
Before a day off (eg, a weekend), what is your latest GOOD MORNING TIME? ____:____ PM/AM
Before a day off (eg, a weekend), what is your usual GOOD MORNING TIME? ____:____ PM/AM
How stable (ie, similar each night) are your GOOD MORNING TIMES on a night before a day off (eg, a weekend)? (circle one) 0-15 m 16-30 m 31-45 m 46-60 m
61-75 m 76-90 m 91-105 m 106-120 m
2-3 h 3-4 h >4 h  
These questions are about how much sleep you lose to unwanted wakefulness:
On most nights, how long, on average, does it take you to fall asleep after you start trying? ________ minutes
On most nights, how much sleep do you lose, on average, from waking up during the night (eg, to go to the bathroom)? ________ minutes
Instructions: This questionnaire asks about when you normally sleep. We are interested in getting as accurate a picture as we can of the times when you normally go to bed and get up. Please think carefully before giving your answers and be as accurate and as specific as you can be. Please answer in terms of a recent "normal average week," not one in which you traveled, vacationed, or had family crises.
h: hours; m: minutes.
Republished with permission of the American Academy of Sleep Medicine, Monk TH, Buysse DJ, Kennedy K, et al. Measuring sleep habits without using a diary: The sleep timing questionnaire. Sleep 2003; 26:208. Copyright © 2003; permission conveyed through Copyright Clearance Center, Inc.
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