Introducing the College Sleep Questionnaire: A new pilot-tested formative assessment of student sleep.
|
|
- Miles Grant
- 6 years ago
- Views:
Transcription
1 Introducing the College Sleep Questionnaire: A new pilot-tested formative assessment of student sleep. Lisa Broek, M.A., Birdie Cunningham, M.A., Caitlin Kelly, B.S., J. Roxanne Prichard, Ph.D. ACHA 2014, 5/28/2014, WE3-186 Disclosures We have no financial disclosures to report. We are grateful to the ACHA for providing the Spring 2009 NCHA data set for analysis and to the ACHA UnitedHealthCare grant which funded this project. 1
2 Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for young adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps Sleep is at the base of Maslow s Hierarchy of Needs. 2
3 How many of the past 7 days did you get enough sleep so that you felt rested when you woke up in the morning? UST National days 2-3 days 4-5 days 6-7 days What are students saying about sleep? 3
4 Consequences of poor sleep in college students Lower Grades Increased Depression Dec. Immunity Inc. chance of W or F. Increased Stress & Anxiety Insulin Resistance Increased Accident Risk Increased interpersonal problems Increased BP Inc. Risk-Taking Behavior Inc. Suicidality Weight Gain 4
5 Poor sleep is a greater predictor of earning a lower grade or dropping a class than is binge drinking, marijuana use, physical illness. Sleep Problems by GPA D/F C B A Z-Score- Problems with Sleep Timing N=81,528 50% Any infectious illness in last 12 months 40% 30% 20% 10% Last 7 days: Felt tired/sleepy during the day 5
6 40% 35% 30% 25% 20% 15% 10% 5% 0% % Ever Seriously Considered Suicide 0 days 1 day 2 days 3 days 4 days 5 days 6 days 7 days Last 7 days: Felt tired/sleepy during the day Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for young adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps 6
7 Insights from Spring 2013 NCHA 19.4% of students report that sleep difficulties negatively affecting academic performance. 26.9% report that sleep problems are traumatic or very difficult to handle 26% report receiving any information about sleep from their campus, yet 51% report wanting more information about achieving healthy sleep from their campuses. Sleep isn t high on the list of parents health concerns. 7
8 Sleep in America Poll 2014: Sleep in the Modern Family how today's modern family sets rules for sleep, navigates the use of technology in the bedroom, how parents can serve as sleep models for their family and make the dream of a "sleep healthy home" come true. Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for Young Adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps 8
9 Why do we need a new Sleep Questionnaire for college students? Most existing pediatric questionnaires aren t appropriate for young adults lives. Most adult questionnaires don t cover the primary sleep problems of young adults. Most sleep assessment instruments are focused on a particular aspect of sleep, rather than serving as a comprehensive, formative assessment. Both students and clinicians need more specific common dialogue for discussing sleep problems. Pediatric questionnaires don t extend to late adolescence. 9
10 Insomnia Severity Index Charles M. Morin, Ph.D., Université Laval Insomnia Severity Index 10
11 Insomnia Severity Index Think about your vocabulary for healthy eating Are you as comfortable talking about sleep? 11
12 Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for Young Adults 4) Development & Structure of the College Sleep Questionnaire 5) CSQ Psychometric Data & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps Relevant Background Literature 12
13 Development Spruyt & Gozal (2011) Purpose We wanted to develop a screening tool for clinicians, researchers, and students to use to better identify and address sleep problems common among college students. This is not a clinical diagnostic tool; instead it s a screening measure to help identify when more in depth diagnostic tests might be necessary. The CSQ can give individualized feedback to each student regarding specific ways to improve sleep. 13
14 Development Process Literature review Discussion with psychologists, psychiatrists, sleep pulmonologists, college nursing staff members, college students Three rounds of pilot testing University of St. Thomas, Fall 2012 (n > 30) University of St. Thomas, Spring 2013 (n > 400) UST & Macalester College, Fall- Spring 2014 (n > 500) Statistical Concerns Reliability- test-retest consistency Validity- Test measures what you intend it to measure Sensitivity- Correctly identifies all who have particular trait (low false negatives) Specificity- Only identifies all who have particular trait (low false positives) 14
15 CSQ Format I. Mixture of open ended questions and likert scale II. Sleep disturbances are indicated by at least once a week designation III. Complete survey takes about minutes to complete CSQ Content I. Motivations to change behavior & self-assessment of sleep disturbances II. Sleep Scheduling: Rise times, Bed times, all 7 days of the week, Sleep Latency, Sleep Inertia III. Sleepiness: Impairment in daytime functioning, drowsy driving IV. Sleep Disturbances (~30 questions) I. Physical II. Stress & Time Management III. Sleep Hygiene 15
16 CSQ Scoring We used principal component analysis to develop algorithms for detecting nine distinct clusters of sleep problems. Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for Young Adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps 16
17 How often do you arrange activities for optimal nighttime sleeping? 51% never/rarely 35% sometimes 11% most of the time 1% always What prevents you from getting the sleep you need? Academics 29% Social/Med 20% Extracurricular 14% Anxiety 10% Sleep Environment 9% Time Management 8% People 5% Physical 1% 17
18 Average Total Sleep Time Average Total Hours Average Sleep Latency (Min) 14% under 5 min. 57% 5 20 min. 28% >20 min. 18
19 National College Health Assessment Sleep Questions 1. Last 12 months diagnosed/treated: Insomnia 2. Last 12 months diagnosed/treated: Other sleep disorder 3. Last 12 months difficult to handle: Sleep difficulties 4. Academic performance negatively affected by sleep difficulties 5. Last 7 days: Enough sleep to feel rested 6. Last 7 days: Problem with sleepiness 7. Last 7 days: Awakened too early 8. Last 7 days: Felt tired/sleepy during the day 9. Last 7 days: Gone to bed because could not stay awake 10. Last 7 days: Extremely hard time falling asleep 11. Ever - Felt exhausted In the last week, how many days have you felt tired or sleepy during the day? ACHA Spring 2013 n=40,900 University of St. Thomas and Macalester n=636 19
20 The Epworth Sleepiness Scale Sleep Disorders, Health, and Safety in Police Officers Rajarantam et al., JAMA, December 21, 2011, Vol 306, No. 23 n=
21 Students Epworth Sleepiness Scale The CSQ estimate of Excessive Daytime Sleepiness strongly correlates with ESS. Short Sleep Latency Long sleep inertia Naps Days Sleepy ESS TOTAL 21
22 Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for Young Adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps 1. Insufficient Sleep (Somnorexia) 22
23 1. Insufficient Sleep (Somnorexia) Short sleep latency Sleep less than 7 hours a night Excessive Sleepiness 24% of sample population 2. Sleep Disordered Breathing A Tool to Screen Patients for Obstructive Sleep Apnea. Chung, et al. Anesthesiology 2008; 108: Copyright 2008, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. 23
24 2. Sleep Disordered Breathing AM Headaches Told about snoring Excessive Sleepiness 5.5% of sample population 3. Narcolepsy 60% of patients were initially misdiagnosed. The most common misdiagnosis was depression, followed by insomnia and obstructive sleep apnea. (Patients Journeys to a Narcolepsy Diagnosis; Lawrence P Carter, PhD, Christine Acebo, PhD, AnnY Kim, MA) 24
25 3. Narcolepsy Feel rubbery with strong emotions See / feel things that may not be real upon awakening Excessive Daytime Sleepiness Nightmares 3% of sample population 4. Restless Leg Syndrome 25
26 4. Restless Legs Syndrome Itching feeling in legs when trying to fall asleep Long sleep latency Can t relax body for sleep 5.7% of sample population 5. Circadian Misalignment 26
27 5. Circadian Misalignment Long sleep latency Not tired when time for bed Can t relax body Evening chronotype Late midsleep 3% of sample population 6. Probable Mood Disorder 27
28 6. Probable Mood Disorder Feeling over-extended Trouble relaxing body Racing thoughts Sleep onset insomnia Sleep maintenance insomnia Nightmares 14% of sample population 7. Poor Time Management 28
29 7. Poor Time Management Doesn t arrange schedule for sleep Can t keep track of things to do Stays up later than planned to complete tasks 14% of population 8. Probable Stimulant Sedation Loop Problems 29
30 8. Probable Stimulant Sedation Loop / Substance Use Problems Uses stimulants to wake up Uses depressants to fall asleep 20% of population 9. Poor Sleep Hygiene 30
31 9. Poor sleep hygiene Not turning off phone Not arranging schedule to optimize sleeping Using electronics before bed Keeping an irregular weekweekend schedule Any Identified Probable Sleep Problem 57% had at least 1 identified probable sleep problem. Those without any identified sleep problem had higher GPAs (p =.06), less daytime sleepiness. 31
32 Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for Young Adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps Intervention: Sleep Squad 32
33 Wellness Center Sleep Squad Program Sent out request s to targeted faculty, coaches, organizations Hired a student worker dedicated to Sleep Squad Set up Sleep Squad schedule Outreach 21 Classrooms 437 Students 4 Athletic Teams 145 students Campus Peer Ministry Students and Wellness Center Student Workers Student Health Service Staff and Counseling and Psychological Services Sleep Squad Results Students were: more willing to change their sleep habits, t(129)=-3.5, p<0.001 feeling less sleepy, t(128)=2.3, p<0.03 going to sleep earlier on weekends, t(113)=2.4, p<0.02 decreased Epworth Sleepiness Scale score, t(129)=4.3, p<
34 Improvements in Stages of Change PRE POST What one or two things are you willing to change to improve your sleep in the next month? Sleep Timing/Extension 36% Sleep Environment/Routine 33% Time Management 27% Limit Caffeine 4% 34
35 Macalester College, St. Paul, MN Small, private liberal arts college (enrollment of 2,000) Highly selective Two year residency requirement Student/faculty ratio of 10 to 1 2 out of 3 students study abroad most for at least 12 weeks FIRST-YEAR COURSE SLEEP PROJECT Pilot Fall first-year courses = 2 control, 2 education Met 5 times total over semester Pre-test (first week of classes) Three 10-minute sessions throughout semester Reinforcement of message by professor Post-test (end of semester, right before finals) Year 3 Fall first-year courses receiving education 3 times a semester Pre-post Design Year 2 Fall first-year courses all receiving education 35
36 Average 5/30/2014 Last 7 Days: Gotten enough sleep to feel rested next morning Control n= Program n= n= n=201 Pre Post Trends found after Macalester curriculum infusion program More days enough sleep Less days up too early Getting to sleep at more consistent bedtimes More likely to change their sleep patterns Lower score on Epworth Sleepiness Scale Students sleeping habits did not get worse, which is a HUGE success!! 36
37 Outline 1) Epidemic of Poor Sleep in College Students 2) Professional Practice Gap in Sleep Education 3) Need for a Formative Sleep Assessment for Young Adults 4) Development & Structure of the CSQ 5) CSQ Psychometrics & Comparison to Published Data 6) Scoring CSQ: 9 Profiles of Disturbed Sleep 7) Pilot use in a pre-post 2-campus intervention study 8) Next steps College Sleep Questionnaire Working with software developers to make the CSQ tool online, and individualized to campuses. For more information about the CSQ, please add your name to the sign up sheet. 37
38 38
Attacking the Roadway Sleep Zombies
Towards Zero Deaths Conference Attacking the Roadway Sleep Zombies Birdie Cunningham, MA, University of St. Thomas J. Prichard, Ph.D, University of St. Thomas Gail Weinholzer, M.B.C., AAA-The Auto Club
More informationSleep History Questionnaire B/P / Pulse: Neck Circum Wgt: Pulse Ox
2700 Campus Drive, Ste 100 2412 E 117 th Street Plymouth, MN 55441 Burnsville, MN 55337 P 763.519.0634 F 763.519.0636 P 952.431.5011 F 952.431.5013 www.whitneysleepcenter.com Sleep History Questionnaire
More informationSleep Questionnaire. If yes, what? If yes, how would you describe it? Please explain? If yes, what times are these?
THE ADRENAL THYROID REVOLUTION Professional Mastermind Aviva Romm MD Sleep Questionnaire Sleep is important for musculoskeletal healing and for healthy immune function, mood, cognitive and brain function,
More informationIowa Sleep Disturbances Inventory (ISDI)
Department of Psychological & Brain Sciences Publications 1-1-2010 Iowa Sleep Disturbances Inventory (ISDI) Erin Koffel University of Iowa Copyright 2010 Erin Koffel Comments For more information on the
More informationHEALTH 3--DEPRESSION, SLEEP, AND HEALTH GOALS FOR LEADERS. To educate participants regarding the sleep wake cycle.
HEALTH 3--DEPRESSION, SLEEP, AND HEALTH GOALS FOR LEADERS Talk about the relationship between depression, sleep, and health problems. To educate participants regarding the sleep wake cycle. To provide
More informationPediatric Sleep Questionnaire
Pediatric Sleep Questionnaire Date Child's Name: Age Gender DOB Referring Physician: Primary Care Physician: Please answer fill out the following questionnaire regarding your child's sleep: What are your
More informationSleep and Traumatic Brain Injury (TBI)
Sleep and Traumatic Brain Injury (TBI) A resource for individuals with traumatic brain injury and their supporters This presentation is based on TBI Model Systems research and was developed with support
More informationTreating Insomnia in Primary Care. Judith R. Davidson Ph.D., C. Psych. Kingston Family Health Team
Treating Insomnia in Primary Care Judith R. Davidson Ph.D., C. Psych. Kingston Family Health Team jdavidson@kfhn.net Disclosure statement Nothing to disclose A ruffled mind makes a restless pillow. ~ Charlotte
More informationSLEEP EVALUATION QUESTIONNAIRE
Specialty Care Center SLEEP PROGRAM Patient Questionnaire ------------------------------------------------------------------------------------------------------------------------------------------ SLEEP
More informationPediatric Sleep History
Fax 423-431-2983 Pediatric Sleep History Patient/ Child s Name: Date of Birth: Parent Name: Last 4 of Social Security No: Gender: Male Female Height: Weight: Age: Race: Street Address: City: State: Zip:
More informationSleep and Students. John Villa, DO Medical Director
Sleep and Students John Villa, DO Medical Director Objectives: Importance and Benefits of Sleep States and Stages of the Sleep Cycle Sleep Needs, Patterns and Characteristics for All Ages Healthy Sleep
More informationArticle printed from
What Are Sleep Disorders? Sleep disorders are conditions that affect how much and how well you sleep. The causes range from poor habits that keep you awake to medical problems that disrupt your sleep cycle.
More informationFacts about Sleep. Circadian rhythms are important in determining human sleep patterns/ sleep-waking cycle
Sleep Sleep is described as a state of unconsciousness or partial consciousness from which a person can be roused by stimulation Period of rest and recovery People spend about a third of their lives sleeping
More informationNot Sleepy HO Q1 D2 Q3 Q4 ]5 D6 j7 Q8 Q9 Q10 Extremely Sleepy
Health Benefits Employee Services HBE Preventive Health - Sleep Assessment Form Please bring your completed assessment form to your appointment. To schedule an appointment please call 505 844-HBES (4237).
More informationBeyond Sleep Hygiene: Behavioral Approaches to Insomnia
Beyond Sleep Hygiene: Behavioral Approaches to Insomnia Rocky Garrison, PhD, CBSM Damon Michael Williams, RN, PMHNP-BC In House Counseling Laughing Heart LLC 10201 SE Main St. 12 SE 14 th Ave. Suite 10
More informationth Ave NE Suite F Bellevue, WA Phone: (425) Fax: (425) Excessive Daytime Sleepiness
1414 116 th Ave NE Suite F Bellevue, WA 98004 Phone: (425) 451-8417 Fax: (425) 455-4089 Excessive Daytime Sleepiness Nearly everyone has days when they feel sleepy. But for some people, excessive sleepiness
More informationIntake Questionnaire
Intake Questionnaire In order to make the best use of your appointment time, please complete this form prior to your initial appointment. What is your name? (Who filled in this form?) (Y= yes N=no DK=
More information*521634* Sleep History Questionnaire. Name of primary care doctor:
*521634* Today s Date: Sleep History Questionnaire Appointment Date: Please answer the following questions before coming to your appointment. Please arrive 15 minutes early with this packet filled out.
More informationHome Sleep Testing Questionnaire
Home Sleep Testing Questionnaire Patient Name: DOB: / / Gender: Male Female Study Date: / / Marital Status: Married Cohabitate Single Divorced Widow/Widower Email: Phone: Height: Weight: Neck Size: What
More informationPULMONARY & CRITICAL CARE CONSULTANTS OF AUSTIN 1305 West 34 th Street, Suite 400, Austin, TX Phone: Fax:
Name: Sex: Age: Date: Date of Birth Height Weight Neck size Referring Physician: Primary Care MD: Main Sleep Complaint(s) trouble falling asleep trouble remaining asleep excessive sleepiness during the
More informationSLEEP QUESTIONNAIRE. Please briefly describe your sleep or sleep problem:
SLEEP QUESTIONNAIRE Your answers to the following questions will help us to obtain a better understanding of your sleep problems. Please answer every question to the best of your ability. It is helpful
More informationPEDIATRIC SLEEP EVALUATION
PEDIATRIC SLEEP EVALUATION Directions: Please answer each of the following questions by writing in or choosing the best answer. This will help us know more about your family and your child. CHILD S INFORMATION
More informationSleep Evaluation Questionnaire
Directions Sleep Evaluation Questionnaire Please answer each of the following questions by writing in or choosing the best answer. This will help us know more about your family and your child. CHILD S
More informationAustralian Centre for Education in Sleep (ACES)
Australian Centre for Education in Sleep (ACES) High School workbook 1 Table of Contents for High School student workbook Topic Page 1. Introduction Dear Student 1 2. Top five reasons why you need to sleep
More informationHow to Help Your Clients Get Better Sleep
How to Help Your Clients Get Better Sleep Bonus Video 1 10-Point Checklist for Getting Better Sleep with Rubin Naiman, PhD How to Help Your Clients Get Better Sleep 2 10-Point Checklist for Getting Better
More informationBMI: Family physician : Neck circumference (cm) Hypertension + 4 cm Snoring + 3 cm Witnessed apnea + 3cm Total
Last and first names: F M Date: Date of birth: / / YYYY MM DD Weight: kg /lbs Profession/job: Height: _ cm /ft.in. BMI:_ Family physician : ANC (adjusted neck circumference) : Neck circumference (cm) Hypertension
More informationModule 22: Fact or Falsehood?
Module 22: Fact or Falsehood? Concept: Before teaching a module or unit, students may have preconceptions about the material. Preconceptions may be false, which can hinder students from learning the material
More informationWHEN COUNTING SHEEP FAILS: ADMINISTERING SINGLE-SESSION COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA IN A GROUP PSYCHOEDUCATIONAL FORMAT
WHEN COUNTING SHEEP FAILS: ADMINISTERING SINGLE-SESSION COGNITIVE-BEHAVIORAL THERAPY FOR INSOMNIA IN A GROUP PSYCHOEDUCATIONAL FORMAT Kristin E. Eisenhauer, PhD. Trinity University San Antonio, Texas I
More informationSleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address
Patient Label For office use only Appt date: Clinician: Sleep Center Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 Leading
More informationSleeping Well. Tips for students. Presented by: Jeanette Gascho. Campus Wellness
Sleeping Well Tips for students Presented by: Jeanette Gascho Campus Wellness In this seminar you will learn: Sleep health facts Stats about University of Waterloo students Sleep health tips Campus Wellness
More informationHEALTHY LIFESTYLE, HEALTHY SLEEP. There are many different sleep disorders, and almost all of them can be improved with lifestyle changes.
HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep disorders, and almost all of them can be improved with lifestyle changes. HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep
More informationSLEEP QUESTIONNAIRE. Name: Sex: Age: Date: DOB: / / SSN: - - Address: Referring Physician: Family Physician: Height: Weight: Neck Size: Phone:
SLEEP QUESTIONNAIRE Name: Sex: Age: Date: DOB: / / SSN: - - Address: Referring Physician: Family Physician: Height: Weight: Neck Size: Phone: Please fill in the blanks, and check appropriate areas on the
More informationIndex. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Actigraphy, 475, 485, 496 Adolescents, sleep disorders in, 576 578 Adults, sleep disorders in, 578 580 Advanced sleep phase disorder, 482 Age,
More informationLet s Sleep On It. Session Overview. Let s Sleep On It. Welcome and Introductions Presenter: Rita Piper, VP of Wellness
Let s Sleep On It Let s Sleep On It Welcome and Introductions Presenter: Rita Piper, VP of Wellness Session Overview Why Sleep is so Important Types of Sleep Common Sleep Disruptors Sleep Disorders Tips
More informationSleep Questionnaire Name: Sex: Age: Da te: Da te of birth: Height: Weight: Neck siz e: Ref erring Physician: Primary Car e MD:
www.myvcmf.com 1133 E. Stanley Blvd., Suite 101 Livermore, CA 94550 925 454-4280 5725 W. Las Positas Blvd., Suite 110 Pleasanton, CA 94588 925-416-6767 Sleep Questionnaire Name: Sex: Age: Da te: Da te
More informationAshok K. Modh, M.D., F.C.C.P. Naishadh K. Mandaliya, M.D., F.C.C.P. Jerges J. Cardona, M.D. Nirav B. Patel, M.D.
Ashok K. Modh, M.D., F.C.C.P. Naishadh K. Mandaliya, M.D., F.C.C.P. Jerges J. Cardona, M.D. Nirav B. Patel, M.D. Dear, Your physician has requested that you be scheduled for a sleep study. Your appointment
More informationAssociated Neurological Specialties and Sleep Disorder Center
Sleep Center Questionnaire Name: Sex: Age: Date: Date of Birth: Height: Weight: Neck Size: Primary Care Physician: Referring Physician: Main Sleep Issues/Complaints Trouble falling asleep Trouble staying
More informationEmergency Contact Information Name: Phone: Address: Employer Information Employer Name: Address/Street: City: Zip: Phone: Fax:
SUNSET SLEEP LABS PATIENT INFORMATION FORM Patient Information Name: Sex: M F Date of Birth: Address/Street: City: Zip: Phone: Alt Phone: Parent/Guardian: Phone: Social Security Number: Drivers License:
More informationSleep History Questionnaire. Sleep Disorders Center Duke University Medical Center. General Information. Age: Sex: F M (select one)
Sleep History Questionnaire Sleep Disorders Center Duke University Medical Center Part I: General Information Name: Address: Date: Phone: Age: Sex: F M (select one) Education (years of school): Occupation:
More informationSLEEP LOG INSTRUCTIONS. Please keep a daily log of your child's sleep for every day (for up to two weeks) before their clinic visit.
SLEEP LOG INSTRUCTIONS Please keep a daily log of your child's sleep for every day (for up to two weeks) before their clinic visit. To show the time your child gets in bed, please mark that time with a
More informationSLEEP EVALUATION QUESTIONNAIRE
Directions Please answer each of the following questions by writing in or choosing the best answer. This will help us know more about your family and your child. CHILD S INFORMATION Child s name: Child
More informationMaintenance for Wakefulness Testing (MWT)
Maintenance for Wakefulness Testing (MWT) Dear, Your Maintenance for Wakefulness Testing (MWT) will begin on the morning of at 7 a.m. and will end at 5 p.m. ARRIVAL TIME: If you are not able to arrive
More informationTHE PERMANENTE MEDICAL GROUP
Patient label here THE PERMANENTE MEDICAL GROUP Division of Sleep Medicine COMPLETED BY: PARENT/GUARDIAN CHILD/ADOLESCENT Age: Height: Weight: PEDIATRIC SLEEP QUESTIONNAIRE Thank you completing this questionnaire.
More informationA GUIDE TO BETTER SLEEP. Prepared by Dr Grant Willson Director, Sleep and Lifestyle Solutions
A GUIDE TO BETTER SLEEP Prepared by Dr Grant Willson Director, Sleep and Lifestyle Solutions A GUIDE TO BETTER SLEEP Good sleep is one of life s pleasures. Most people can think of a time when they slept
More informationNash Sleep Disorders Center 250 Medical Arts Mall Suite C Rocky Mount NC Phone: Fax:
Appointment Date: Arrival Time: *Please give at least 24 hour notice if you are unable to keep your appointment or need to reschedule. 1. Patients will need to bring pictured identification, insurance
More informationGet on the Road to Better Health Recognizing the Dangers of Sleep Apnea
Get on the Road to Better Health You Will Learn About The importance and benefits of sleep Sleep deprivation and its consequences The prevalence, symptoms, and treatments for major sleep problems/ disorders
More informationAdolescent Sleep Disorder Questionnaire For Children Ages PATIENT NAME: (Please print clearly) Patient s Date of Birth: Age: Male Female
(PATIENT) Adolescent Sleep Disorder Questionnaire For Children Ages 12-17 Instructions: Please review this form for accuracy prior to submission. You may complete this information prior to arrival at the
More informationIndividual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems.
COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems. Individual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems.
More informationHealthy Sleep Tips Along the Way!
Women and Sleep What You Will Learn The Benefits and Importance of Sleep States and Stages of the Sleep Cycle Unique Physiology of Women s Sleep Common Disorders in Women that Affect Sleep Women s Role
More informationSleep & Relaxation. Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique
Sleep & Relaxation Sleep & Relaxation Session 1 Understanding Insomnia Sleep improvement techniques Try a new technique Session 2 Dealing with unhelpful thoughts Putting these techniques together for better
More informationMaintenance for Wakefulness Testing (MWT)
SLEEP DISORDERS CENTER St. Joseph Mercy Ann Arbor 5305 Elliott Drive, Ypsilanti, MI 48197 734-712-2276 / Fax 734-712-2967 Maintenance for Wakefulness Testing (MWT) Dear, Your Maintenance for Wakefulness
More informationHumble Dreams Sleep Center. Humble, TX 77339
Humble Dreams Sleep Center 8901 FM 1960 Bypass West, Ste. 306 Humble, TX 77339 Dear Humble Dreams Sleep Study Patient, Thank you for allowing Humble Dreams Sleep Center to provide your sleep study as requested
More informationTen tips for a good night s sleep
Ten tips for a good night s sleep This task set contains: Teacher instructions Reading text Learner response sheet Answer key Marking and feedback to learners When marking the learners' responses please
More informationTraumatic Brain Injury and Sleep
Traumatic Brain Injury and Sleep Javier has a hard time falling asleep and his lack of sleep made his anxiety worse. He Also became fatigued and irritable easily, It really made our lives harder. Sleep
More informationSleep Symptoms & History
Sleep Symptoms & History In your own words, please tell us what brings you to the sleep clinic today? How long have you been experiencing your sleep problems? yrs. mos. To give us a precise understanding
More informationSleep Center New Patient Questionnaire
For office use only Appt date: Sleep Center Clinician: Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 #1 respiratory hospital
More informationSLEEP & MEDICAL HISTORY QUESTIONNAIRE
SLEEP & MEDICAL HISTORY QUESTIONNAIRE Patient Name Sex Age Date Please complete the following questionnaire by placing a check in the appropriate areas and filling in the blanks. My Main Sleep Complaint(s)
More informationRobert E. McMichael, M.D. Medical Director Patient Instructions for a Diagnostic Sleep Study
NORTH TEXAS SLEEP DISORDERS CENTER Neurology Associates of Arlington, P.A 811 West Interstate 20, Suite G12 Arlington, Texas 76017 (817) 419-6375 Fax (817) 419-6371 Robert E. McMichael, M.D. Medical Director
More informationAutism Spectrum Disorder and Sleep. Jack Dempsey, Ph.D.
Autism Spectrum Disorder and Sleep Jack Dempsey, Ph.D. 3 Things Sleep Chart Bedtime Routine Independent Sleep Sleep Get more sleep Exercise Exercise more The Big 4 Eat Eat healthier Be Be more mindful
More informationA good night s sleep
A good night s sleep Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm A good night
More informationTOP 10 LIST OF SLEEP QUESTIONS. Kenneth C. Sassower, MD Sleep Disorders Unit Massachusetts General Hospital for Children
TOP 10 LIST OF SLEEP QUESTIONS Kenneth C. Sassower, MD Sleep Disorders Unit Massachusetts General Hospital for Children QUESTION #1: ARE SLEEP ISSUES IN CHILDREN THE SAME AS IN ADULTS? Distinctive Features
More informationNational Sleep Foundation
National Sleep Foundation National Sleep Foundation 2003 Prepared by: Date: March 10, 2003 National Sleep Foundation 1522 K Street, Suite 500, NW Washington, DC 20005 Ph: (202) 347-3471 Fax: (202) 347-3472
More informationSLEEP DISORDERS. Kenneth C. Sassower, MD Division of Sleep Medicine; Department of Neurology Massachusetts General Hospital for Children
SLEEP DISORDERS Kenneth C. Sassower, MD Division of Sleep Medicine; Department of Neurology Massachusetts General Hospital for Children Distinctive Features of Pediatric Sleep Daytime sleepiness uncommon
More informationSleep and mental wellbeing: exploring the links
Sleep and mental wellbeing: exploring the links Like most physiological functions, the length and quality of sleep is influenced by a host of biological, environmental and lifestyle factors. Across all
More informationSection of Pediatric Sleep Medicine
Section of Pediatric Sleep Medicine David Gozal, MD Hari Bandla, MD Date: Dear Parent or Caregiver; Thank you for your interest in the Sleep Disorders Program. The sleep clinic s standard assessment procedure
More information604 NORTH ACADIA ROAD, Suite 210 THIBODAUX, LA SLEEP HISTORY QUESTIONNAIRE
604 NORTH ACADIA ROAD, Suite 210 THIBODAUX, LA 70301 985-493-4759 SLEEP HISTORY QUESTIONNAIRE DATE: / / NAME: AGE (First) (Middle) (Last) ADDRESS: (Street) (City) (State) (Zip) PHONE: Home( ) Work:( )
More informationMany people with physical
FACTSHEET How to Sleep Better Many people with physical disabilities suffer from sleep disturbances, and sleep tends to become more disrupted as we get older. Not sleeping well can negatively impact your
More informationSleep and Ageing. Siobhan Banks PhD. Body and Brain at Work, Centre for Sleep Research University of South Australia
Sleep and Ageing Siobhan Banks PhD Body and Brain at Work, Centre for Sleep Research University of South Australia Health and Active Ageing, 22 nd September 2015 Sleep and Aging How does sleep change as
More informationBetter Bedtime Routines. Michelle Mogenson, D.O. Children s Physicians Spring Valley
Better Bedtime Routines Michelle Mogenson, D.O. Children s Physicians Spring Valley Outline Sleep expectations Guidance on how to improve sleep Infant sleep methods What you want: Why are you here? Why
More informationSweet Dreams. Guide to Getting a Good Night s Sleep
Sweet Dreams Guide to Getting a Good Night s Sleep Objectives Learn sleep facts, common myths about sleep, and the consequences of sleep deprivation Discover how sleep works and what interferes with sleeping
More informationOccupation: Usual Work Hours/Days: Referring Physician: Family Physician (PCP): Marital status: Single Married Divorced Widowed
Name Social Security No. Last First MI Address Phone No. ( ) City State Zip Secondary No. ( ) Date of Birth Sex (M/F) Race Email County Primary Care Marital Status Single Divorced Married Widowed Employer
More informationSLEEP DISORDERS CENTER QUESTIONNAIRE
Carteret Health Care Patient's name DOB Gender: M F Date of Visit _ Referring physicians: Primary care providers: Please complete the following questionnaire by filling in the blanks and placing a check
More informationHOW TO DEAL WITH SLEEP PROBLEMS
The Handbook on Successful Ageing HOW TO DEAL WITH SLEEP PROBLEMS Up to 50% of the elderly complain of insomnia, but although such complaints are prevalent and are often accompanied by higher rates of
More informationAssessment of Sleep Disorders DR HUGH SELSICK
Assessment of Sleep Disorders DR HUGH SELSICK Goals Understand the importance of history taking Be able to take a basic sleep history Be aware the technology used to assess sleep disorders. Understand
More informationSleep: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016
Sleep: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016 Lesson Objectives Understand the importance of having consistent, quality
More informationSleep Disorders Diagnostic Center 9733 Healthway Drive, Berlin, MD , ext. 5118
Sleep Questionnaire *Please complete the following as accurate as possible. Please bring your completed questionnaire, insurance card, photo ID, Pre-Authorization and/or Insurance referral form, and all
More informationSleep is Critical to a Child s Development, Health and Quality of Life
Sleep is Critical to a Child s Development, Health and Quality of Life Childhood is an Opportune Time for Parents to Help Their Children Establish Good Sleep Habits This is important for: Prevention of
More informationWelcome to the Choose Life Balance self-study course from K-State Research & Extension.
Welcome to the Choose Life Balance self-study course from K-State Research & Extension. 1 This self-study course will examine five topics that are important for balanced living: time management, stress
More informationSLEEP STUDY. Nighttime. 1. How many hours of sleep are you now getting in a typical night?
SLEEP STUDY Patient Name: Date of Birth: Date of Study: This questionnaire involves a broad range of sleep and sleep-related behaviors. Your answers enable us to develop a clearer picture of your sleep/wake
More informationBaptist Health Floyd 1850 State Street New Albany, IN Sleep Disorders Center Lung & Sleep Specialists. Date of Birth: Age:
Page 1 of 7 GENERAL INFORMATION Name: Date of Birth: Age: Social Security #: Sex: Height: Weight: Address: City: State: Zip: Home Phone: Cell Phone: Work Phone: Employer s Name: Marital Status: Married
More informationInsomnia. F r e q u e n t l y A s k e d Q u e s t i o n s
Insomnia Q: What is insomnia? A: Insomnia is a common sleep disorder. If you have insomnia, you may: Lie awake for a long time and have trouble falling asleep Wake up a lot and have trouble returning to
More informationHow To Cure Insomnia: Discover How To Cure Insomnia Without Drug Or Alcohol, How To Get A Good Night's Sleep And Be Well Rested For Life By Sally M.
How To Cure Insomnia: Discover How To Cure Insomnia Without Drug Or Alcohol, How To Get A Good Night's Sleep And Be Well Rested For Life By Sally M. Dennis Lack of Sleep and the Immune System - WebMD -
More informationManaging Sleep Problems after Cancer
Managing Sleep Problems after Cancer For cancer survivors Read this resource to learn about: What a sleep problem is What causes it What you can do to improve your sleep When to talk to your doctor Please
More informationPEDIATRIC SLEEP QUESTIONNAIRE. Child s Name:,, Last First MI. Name of Person Answering Questions: Relation to child:
PEDIATRIC SLEEP QUESTIONNAIRE Child s Name:,, Last First MI Name of Person Answering Questions: Relation to child: Your phone number, Days: and Evenings: Area Code Number Area Code Number Relative s name
More informationYOU REALLY NEED TO SLEEP: Several methods to improve your sleep
YOU REALLY NEED TO SLEEP: Several methods to improve your sleep Sleep is essential to our well-being. When humans fail to get good sleep over a period of time, numerous problems can occur. CAN T SLEEP!!
More informationContents. Page. Can t sleep 3. Insomnia 4. Sleep 5. How long should we sleep? 8. Sleep problems 9. Getting a better night s sleep 11
I Cannot Sleep Contents Page Can t sleep 3 Insomnia 4 Sleep 5 How long should we sleep? 8 Sleep problems 9 Getting a better night s sleep 11 Treatment for insomnia 15 For more information 19 2 Can t sleep
More informationADHD and Sleep. Dr. Jessica Agnew-Blais MRC Postdoctoral Fellow SDGP Centre Institute of Psychiatry, Psychology & Neuroscience
ADHD and Sleep Dr. Jessica Agnew-Blais MRC Postdoctoral Fellow SDGP Centre Institute of Psychiatry, Psychology & Neuroscience Who am I? Who I am: ADHD researcher Parent Who I am not: Clinician Sleep expert
More informationInstructions. If you make a mistake, put an "X" over the checkmark. Then put a checkmark in the correct box and draw a circle around that box.
SLEEP HEART HEALTH STUDY SLEEP HABITS AND LIFESTYLE QUESTIONNAIRE Instructions Thank you for taking time to fill out the enclosed Sleep Habits Questionnaire. Please fill out the form completely. You may
More informationALVIN C. BURSTEIN, MD PATIENT CLIENT INFORMATION
ALVIN C. BURSTEIN, MD PATIENT CLIENT INFORMATION LEGAL Name Date of Birth (must match insurance card) Address City State Zip Mailing Address City State Zip (If different) Phone: Cell Home Appt. reminders
More informationSleep History Questionnaire
Sleep History Questionnaire Name: DOB: Phone: Date of Consultation: Consultation is requested by: Primary care provider: _ Preferred pharmacy: Chief complaint: Please tell us why you are here: How long
More informationSharon A. Chung, PhD Clinical Researcher Youthdale Treatment Centres Sleep Research Laboratory, University Health Network Tel: Fax:
Sharon A. Chung, PhD Clinical Researcher Youthdale Treatment Centres Sleep Research Laboratory, University Health Network Tel: 416-603-5275 Fax: 416-603-5292 sachung@uhnres.utoronto.ca www.sleepontario.com
More informationWhat is the economic burden associated with poor sleep?
AS@W...SLEEP AND DEPRESSION How does depression affect sleep? Depressed mood can significantly impact sleep. Some people find it difficult to fall asleep or stay asleep. Others find that they wake up much
More informationRESTore TM. Clinician Manual for Single User. Insomnia and Sleep Disorders. A step by step manual to help you guide your clients through the program
RESTore TM Insomnia and Sleep Disorders Clinician Manual for Single User A step by step manual to help you guide your clients through the program Version 10 July, 2016 Table of Contents Introduction...
More informationNarendra Kumar, M.D. PC Board Certified ENT Board Certified Sleep Medicine
Narendra Kumar, M.D. PC Board Certified ENT Board Certified Sleep Medicine PATIENT DEMOGRAPHICS Who is the Physician that referred you to us? Who is the primary care Physician? Date: Do you want this report
More informationAssignment 1. Why Joey needs sleep
SLEEP ASSIGNMENTS Assignment 1 Why Joey needs sleep Joey doesn t like to go to bed in the evening, because he thinks sleeping is a waste of time. But he is wrong! His body and his brain need 10 to 12 hours
More informationFatigue. Based on information from FAA briefing prepared by Thomas E. Nesthus, Ph.D.
Fatigue Based on information from FAA briefing prepared by Thomas E. Nesthus, Ph.D. What is fatigue? ICAO s definition: A physiological state of reduced mental or physical performance capability resulting
More informationReference document. Sleep disorders
Reference document Sleep disorders Table of contents Introduction 2 Definition 2 Myths 2 Major determinants 2 Major sleep disorders 3 The consequences of sleep deprivation 3 Tips for better sleep 4 Conclusion
More informationPATIENT NAME: M.R. #: ACCT #: HOME TEL: WORK TEL: AGE: D.O.B.: OCCUPATION: HEIGHT: WEIGHT: NECK SIZE: GENDER EMERGENCY CONTACT: RELATIONSHIP: TEL:
SLEEP DISORDERS INSTITUTE HOSPITAL: DePaul Building Street Address City, State Zip Tel: (202) 555-1212 Fax: (202) 555-1212 SLEEP QUESTIONNAIRE PATIENT NAME: M.R. #: ACCT #: STREET ADDRESS: CITY: STATE:
More informationSLEEP HISTORY QUESTIONNAIRE
Date of birth: Today s date: Dear Patient: SLEEP HISTORY QUESTIONNAIRE Thank you for taking the time to fill out a sleep history questionnaire. This will help our healthcare team to provide the best possible
More informationTHIBODAUX REGIONAL SLEEP DISORDERS CENTER 604 N ACADIA ROAD, Suite 210 THIBODAUX, LA 70301
Name:_ Date: Address: Phone (home): Work: Marital Status: Date of Birth: Height: Weight: In case of emergency contact: ************************************************************************ Social Security#:
More information