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 |
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