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Sleep Heart Health Study

Name Label Folder
formdate_ms
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Date completed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Date completed

Date of Morning Survey form

Questionnaires/SHHS2/Morning Survey
ms204a
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep light/deep
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep light/deep

4. Rate the actual quality of your sleep last night (Do not compare to usual sleep quality). My sleep last night was (circle a number for each): a. [5 point Likert scale from "Light" to "Dark"]

Questionnaires/SHHS2/Morning Survey
ms204b
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep: short/long
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep: short/long

4. Rate the actual quality of your sleep last night (Do not compare to usual sleep quality). My sleep last night was (circle a number for each): b. [5 point Likert scale from "Short" to "Long"]

Questionnaires/SHHS2/Morning Survey
ms204c
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep: restless/restful
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep: restless/restful

4. Rate the actual quality of your sleep last night (Do not compare to usual sleep quality). My sleep last night was (circle a number for each): c. [5 point Likert scale from "Restless" to "Restful"]

Questionnaires/SHHS2/Morning Survey
ms205
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep compared to usual
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Quality of sleep compared to usual

5. Compared to your usual night's sleep, how well did you sleep last night? (check one)

Questionnaires/SHHS2/Morning Survey
ms209a
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): glasses of wine before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): glasses of wine before bed

9. How many of the following drinks did you have during the 4 hours before you went to sleep last night? (Please write "0" if you did not drink any of that beverage.) a. ____ glasses of wine (4 oz.)

Questionnaires/SHHS2/Morning Survey
ms209b
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): mixed drinks before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): mixed drinks before bed

9. How many of the following drinks did you have during the 4 hours before you went to sleep last night? (Please write "0" if you did not drink any of that beverage.) b. ____ drinks with hard liquor (1 shot)

Questionnaires/SHHS2/Morning Survey
ms209c
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): bottles or cans of beer before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): bottles or cans of beer before bed

9. How many of the following drinks did you have during the 4 hours before you went to sleep last night? (Please write "0" if you did not drink any of that beverage.) c. ____ bottles or cans of beer (12 oz.)

Questionnaires/SHHS2/Morning Survey
ms210a
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cups of coffee before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cups of coffee before bed

10. How many of the following drinks with caffeine did you have during the 4 hours before you went to sleep last night? (Please write "0" if you did not drink any of that beverage.) a. ____ cups of regular coffee (with caffeine)

Questionnaires/SHHS2/Morning Survey
ms210b
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cups of tea before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cups of tea before bed

10. How many of the following drinks with caffeine did you have during the 4 hours before you went to sleep last night? (Please write "0" if you did not drink any of that beverage.) b. ____ cups of tea (with caffeine)

Questionnaires/SHHS2/Morning Survey
ms210c
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): glasses or cans of soda before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): glasses or cans of soda before bed

10. How many of the following drinks with caffeine did you have during the 4 hours before you went to sleep last night? (Please write "0" if you did not drink any of that beverage.) c. ____ glasses or cans of cola or other soda (with caffeine)

Questionnaires/SHHS2/Morning Survey
ms211a
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cigarettes before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cigarettes before bed

11. How much did you smoke during the 4 hours before you went to sleep last night? (Please write "0" for each that you did not smoke last night.) a. ____ number of cigarettes

Questionnaires/SHHS2/Morning Survey
ms211b
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): pipe bowls before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): pipe bowls before bed

11. How much did you smoke during the 4 hours before you went to sleep last night? (Please write "0" for each that you did not smoke last night.) b. ____ number of pipe bowls

Questionnaires/SHHS2/Morning Survey
ms211c
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cigars before bed
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): cigars before bed

11. How much did you smoke during the 4 hours before you went to sleep last night? (Please write "0" for each that you did not smoke last night.) c. ____ number of cigars

Questionnaires/SHHS2/Morning Survey
ms212
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Nasal stuffiness, discharge last night
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Nasal stuffiness, discharge last night

12. Did you have nasal stuffiness, obstruction, or discharge last night? (check one)

Questionnaires/SHHS2/Morning Survey
ms212a
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Nasal stuffiness interfered with sleep
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Nasal stuffiness interfered with sleep

12. Did you have nasal stuffiness, obstruction, or discharge last night? a. If yes, did this interfere with your sleep last night? (check one)

Questionnaires/SHHS2/Morning Survey
rptacttimslp
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Reported time actually slept last night
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Reported time actually slept last night Questionnaires/SHHS2/Morning Survey
rptelaptimslpwak
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Reported elapsed time between sleep and wakening
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): Reported elapsed time between sleep and wakening Questionnaires/SHHS2/Morning Survey
rpttimtoslp
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): minutes to fall asleep
Morning Survey (Sleep Heart Health Study Visit Two (SHHS2)): minutes to fall asleep Questionnaires/SHHS2/Morning Survey