| 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 |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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"] |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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"] |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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"] |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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.) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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.) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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 |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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 |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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 |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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) |
Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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 | Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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 | Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 | |
|
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 | Sleep Monitoring/Polysomnography/Evening and Morning Survey/SHHS2 |