Evening & Morning Questionnaire Complete our online form below or Download our Evening & Morning Questionnaire Name * First Name Last Name Date of Birth * MM DD YYYY Study Date: MM DD YYYY EVENING QUESTIONNAIRE Please answer the following questions BEFORE you go to sleep for your at-home sleep study: 1. What time did you get into bed? 2. What time did you turn the lights out? MORNING QUESTIONNAIRE Please answer the following questions as soon as possible when you wake after your sleep test: 1. Did any electrodes or sensors fall off during the course of the night? * Yes No If yes, can you identify from where? 2. Did you drink any alcohol last evening? * Yes No If yes, how many drinks did you have? 3. Did you take any medications to help you sleep last night? * Yes No If yes, what did you take? 4. How long do you think it took you to fall asleep after you switched the lights off? 5. What time did you wake up this morning? 6. What time did you get out of bed this morning? 7. How long did you think you slept for? 8. Did anything disturb your sleep last night? * Yes No If yes, what disturbed you? Please tick the box that best describes your sleep last night. Poor Good Very Good Please tick the box that best describes how your sleep last night compares to normal. Worse Same Better (than usual) Thank you for completing this questionnaire.
