| | Response |
| Morning questions |
- What time did you go to bed (use 24-hour clock or AM/PM)?
| |
- How long did it take you to fall asleep (hours/minutes)?
| |
- Did you wake up during the night last night (yes/no)?
| |
- How many times did you wake up?
| |
- How long were you awake, in total, after you initially fell asleep (hours/minutes)?
| |
- How long did you sleep last night (hours/minutes)?
| |
- Rate the quality of your sleep (1 = excellent; 5 = poor)
| 1 | 2 | 3 | 4 | 5 |
- What time did you wake up this morning (use 24-hour clock or AM/PM)?
| |
- What time did you get out of bed (use 24-hour clock or AM/PM)?
| |
- How difficult was it to wake up? (1 = very easy; 5 = very hard)
| 1 | 2 | 3 | 4 | 5 |
- How alert do you feel now? (1 = wide awake; 5 = very sleepy)
| 1 | 2 | 3 | 4 | 5 |
- How refreshed do you feel? (1 = very rested; 5 = not at all)
| 1 | 2 | 3 | 4 | 5 |
Comments:
|
| Evening questions |
- Did you nap today (yes/no)?
| |
- How long was your longest nap (hours/minutes)?
| |
- What time did your nap start (use 24-hour clock or AM/PM)?
| |
- How much time did you nap, planned plus unplanned (hours/minutes)?
| |
- What activities consumed the majority of your time?
| - Computer
- Television
- Reading/paperwork
- Housework
- Other, specify:
|
