| psqi_date |
|
text |
Date of Completion |
|
| psqi_visit |
|
radio |
Visit |
1, 3 Months ; 2, 12 Months |
| psqi_q1 |
|
text |
1. During the past month, what time have you usually gone to bed at night? |
|
| psqi_q2 |
|
text |
2. During the past month, how long (in minutes) has it usually taken you to fall asleep each night? |
|
| psqi_q3 |
|
text |
3. During the past month, what time have you usually gotten up in the morning? |
|
| psqi_hours_bed |
|
text |
Please calculate the number of hours spent in bed using responses for Questions 1 and Questions 3 (This is required to calculate the score for Component 4: Sleep Efficiency). |
|
| psqi_q4 |
|
text |
4. During the past month, how many hours of actual sleep did you get at night? (This may be different than the number of hours you spent in bed.) |
|
| psqi_q5a |
5. During the past month, how often have you had trouble sleeping because you: |
radio |
a) Cannot get to sleep within 30 minutes |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5b |
|
radio |
b) Wake up in the middle of the night or early morning |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5c |
|
radio |
c) Have to get up to use the bathroom |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5d |
|
radio |
d) Cannot breathe comfortably |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5e |
|
radio |
e) Cough or snore loudly |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5f |
|
radio |
f) Feel too cold |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5g |
|
radio |
g) Feel too hot |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5h |
|
radio |
h) Had bad dreams |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5i |
|
radio |
i) Have pain |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q5j |
|
radio |
j) How often during the past month have you had trouble sleeping because of other reasons? |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_5j_other |
|
notes |
j) Other reasons, please describe |
|
| psqi_q6 |
|
radio |
6. During the past month, how would you rate your sleep quality overall? |
0, Very good ; 1, Fairly good ; 2, Fairly bad ; 3, Very bad |
| psqi_q7 |
|
radio |
7. During the past month, how often have you taken medicine to help you sleep (prescribed or "over the counter")? |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q8 |
|
radio |
8. During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity? |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q9 |
|
radio |
9. During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? |
0, No problem at all ; 1, Only a very slight problem ; 2, Somewhat of a problem ; 3, A very big problem |
| psqi_q10 |
|
radio |
10. Do you have a bed partner or room mate? |
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 |
| psqi_q10a |
If you have a room mate or bed partner, ask him/her how often in the past month you have had: |
radio |
a) Loud snoring |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q10b |
|
radio |
b) Long pauses between breaths while asleep |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q10c |
|
radio |
c) Legs twitching or jerking while you sleep |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q10d |
|
radio |
d) Episodes of disorientation or confusion during sleep |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q10e |
|
radio |
e) Other restlessness while you sleep |
0, Not during past month ; 1, Less than once a week ; 2, Once or twice a week ; 3, Three or more times a week |
| psqi_q10e_other |
|
notes |
e) Other restlessness, please describe |
|
| psqi_comp1 |
|
calc |
Component 1: Subjective Sleep Quality |
[psqi_q6] |
| psqi_comp2_calc |
|
calc |
Sleep Latency Calculation |
if([psqi_q2]="", "", if([psqi_q2]<=15, 0, if([psqi_q2]>=16 and [psqi_q2]<=30, 1, if([psqi_q2]>=31 and [psqi_q2]<=60, 2, 3)))) |
| psqi_comp2 |
|
calc |
Component 2: Sleep Latency |
if(sum([psqi_comp2_calc], [psqi_q5a])="", "", if(sum([psqi_comp2_calc], [psqi_q5a])=0, 0, if(sum([psqi_comp2_calc], [psqi_q5a])=1 or sum([psqi_comp2_calc], [psqi_q5a])=2, 1, if(sum([psqi_comp2_calc], [psqi_q5a])=3 or sum([psqi_comp2_calc], [psqi_q5a])=4, 2, 3)))) |
| psqi_comp3 |
|
calc |
Component 3: Sleep Duration |
if([psqi_q4]="", "", if([psqi_q4]>7, 0, if([psqi_q4]<=7 and [psqi_q4]>6, 1, if([psqi_q4]<=6 and [psqi_q4]>=5, 2, 3)))) |
| psqi_comp4_calc |
|
calc |
Sleep Efficiency Calculation |
([psqi_q4] / [psqi_hours_bed]) * 100 |
| psqi_comp4 |
|
calc |
Component 4: Sleep Efficiency |
if([psqi_comp4_calc]="", "", if([psqi_comp4_calc]>=85, 0, if([psqi_comp4_calc]>=75 and [psqi_comp4_calc]<=84, 1, if([psqi_comp4_calc]>=65 and [psqi_comp4_calc]<=74, 2, 3)))) |
| psqi_comp5_calc |
|
calc |
Sleep Disturbance Calculation |
sum([psqi_q5b], [psqi_q5c], [psqi_q5d], [psqi_q5e], [psqi_q5f], [psqi_q5g], [psqi_q5h], [psqi_q5i], [psqi_q5j]) |
| psqi_comp5 |
|
calc |
Component 5: Sleep Disturbance |
if([psqi_comp5_calc]="", "", if([psqi_comp5_calc]=0, 0, if([psqi_comp5_calc]>0 and [psqi_comp5_calc]<=9, 1, if([psqi_comp5_calc]>=10 and [psqi_comp5_calc]<=18, 2, 3)))) |
| psqi_comp6 |
|
calc |
Component 6: Use of Sleep Medication |
[psqi_q7] |
| psqi_comp7_calc |
|
calc |
Daytime Dysfunction Calculation |
sum([psqi_q8], [psqi_q9]) |
| psqi_comp7 |
|
calc |
Component 7: Daytime Dysfunction |
if([psqi_comp7_calc]="", "", if([psqi_comp7_calc]=0, 0, if([psqi_comp7_calc]=1 or [psqi_comp7_calc]=2, 1, if([psqi_comp7_calc]=3 or [psqi_comp7_calc]=4, 2, 3)))) |
| psqi_global |
|
calc |
PSQI Global Score |
sum([psqi_comp1], [psqi_comp2], [psqi_comp3], [psqi_comp4], [psqi_comp5], [psqi_comp6], [psqi_comp7]) |