PHI stands for "Protected Health Information" (Y = Yes, N = No)
| Display | Field | Phi | Field type | Condition choices | Field note | Header | |
|---|---|---|---|---|---|---|---|
| 1. During the past month, what time have you usually gone to bed at night? (use 24-hour time)_x000D_ _x000D_ Enter values from 00:00 to 23:59 _x000D_ 1:00 is 1 am, early morning _x000D_ 12:00 is noon, also called 12 PM _x000D_ 14:00 is 2pm, early afternoon _x000D_ 20:00 is 8pm, the evening _x000D_ 23:59 is 11:59 pm, late evening _x000D_ 00:00 is midnight, also called 12 AM _x000D_ 00:30 is 30 minutes after midnight_x000D_ _x000D_ _x000D_ | psqi_1 | N | text | - | - | PITTSBURGH SLEEP QUALITY INDEX <br><br> INSTRUCTIONS: <br> The following questions relate to your usual sleep habits during the past month <u>only</u>. Your answers should indicate the most accurate reply for the <u>majority</u> of days and nights in the past month. Please answer all questions. <br> | |
| 2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? | psqi_2 | N | dropdown | 0, 15 min or less | 1, 16-30 min | 2, 31-60 min | 3, more than 60 min | - | - | |
| 3. During the past month, what time have you usually gotten up in the morning?(use 24-hour time)_x000D_ _x000D_ Enter values from 00:00 to 23:59 _x000D_ 1:00 is 1 am, early morning _x000D_ 12:00 is noon, also called 12 PM _x000D_ 14:00 is 2pm, early afternoon _x000D_ 20:00 is 8pm, the evening _x000D_ 23:59 is 11:59 pm, late evening _x000D_ 00:00 is midnight, also called 12 AM _x000D_ 00:30 is 30 minutes after midnight_x000D_ _x000D_ | psqi_3 | N | text | - | - | - | |
| 4. During the past month, how many hours of <u>actual sleep</u> did you get at night? (This may be different than the number of hours you spent in bed.)_x000D_ _x000D_ Enter a decimal number that is a number of HOURS. Round the number of hours to the nearest half hour. You should not enter any words or punctuation, only digits and a decimal point. If the amount of sleep is 8-1/2 hours, enter 8.5 (and nothing else). If the amount of sleep is 6hrs and 10 mins, enter 6 or 6.0, and nothing else. If the amount of sleep is 22hrs and 55 mins, enter 23 or 23.0, and nothing else._x000D_ | psqi_4 | N | text | - | - | - | |
| 5a) Cannot get to sleep within 30 minutes | psqi_5a | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | For each of the remaining questions, check the one best response. Please answer <u>all</u> questions. <br><br> 5. During the past month, how often have you had trouble sleeping because you . . . | |
| 5b) Wake up in the middle of the night or early morning | psqi_5b | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5c) Have to get up to use the bathroom | psqi_5c | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5d) Cannot breathe comfortably | psqi_5d | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5e) Cough or snore loudly | psqi_5e | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5f) Feel too cold | psqi_5f | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5g) Feel too hot | psqi_5g | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5h) Had bad dreams | psqi_5h | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5i) Have pain | psqi_5i | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 5j) Other reason(s), please describe | psqi_5other | Y | notes | - | - | - | |
| How often during the past month have you had trouble sleeping because of this? | psqi_5othera | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 6. During the past month, how would you rate your sleep quality overall? | psqi_6 | N | radio | 0, Very good | 1, Fairly good | 2, Fairly bad | 3, Very bad | - | - | |
| 7. During the past month, how often have you taken medicine to help you sleep (prescribed or "over the counter")? | psqi_7 | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 8. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? | psqi_8 | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 9. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? | psqi_9 | N | radio | 0, No problem at all | 1, Only a very slight problem | 2, Somewhat of a problem | 3, A very big problem | - | - | |
| 10. Do you have a bed partner or room mate? | psqi_10 | N | radio | 0, No bed partner or room mate | 1, Partner/room mate in other room | 2, Partner in same room, but not same bed | 3, Partner in same bed | - | - | |
| 10a) Loud snoring | psqi_10a | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | If you have a room mate or bed partner, ask him/her how often in the past month you have had... | |
| 10b) Long pauses between breaths while asleep | psqi_10b | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 10c) Legs twitching or jerking while you sleep | psqi_10c | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 10d) Episodes of disorientation or confusion during sleep | psqi_10d | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| 10e) Other restlessness while you sleep; please describe | psqi_10e | Y | notes | - | - | - | |
| 10e) How often has that affected you? | psqi_10e1 | N | radio | 0, Not during the past month | 1, Less than once a week | 2, Once or twice a week | 3, Three or more times a week | - | - | |
| Notes | psqi_notes | Y | notes | - | - | - |