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Protocol - Sleep Disorders Screener

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Description:

The National Institute of Mental Health (NIMH) Sleep Patterns and Problems instrument is an interviewer-administered questionnaire which captures routine sleep schedule, sleep deprivation, morningness-eveningness, insomnia, narcolepsy, cataplexy and associated distress.

Protocol:
 

Date: ___________________________________

Interviewer: ______________________________

Co-raters: ________________________________

Duration: _________________________________

I am now going to ask you about your usual sleep patterns.

INTERVIEWER: Please tell participant that they should not reveal their diagnosis to you.

Routine Sleep Schedule

No

Yes

Unk

DASLP999

Do you normally work (or attend school) during the day and sleep at night?

INTERVIEWER: If individual is unemployed and out of school, ask about his/her usual time of activity instead.

0

1

9

Code Response

DASLP999

What is your normal work (or school) and sleep schedule?

1

2

3

 

1 = Always works nights, sleeps during the day

2 = Schedule rotates/Shift Work

3 = Other, Describe:

___________________________________________

___________________________________________

___________________________________________

   

DASLP999

(If response = 2)

What shift schedule do you most often work?

     

1 = Day Shift (approx. 7am- 3pm)

2 = Evening Shift (approx. 3pm- 11pm)

3 = Night Shift (approx. 11pm- 7am)

4 = Other:

1

2

3

4

Use the one shift schedule selected for the following questions regarding your workdays.

At what time do you usually go to bed:

Time

DASLP999

On a workday or school day?

____: ___

□ AM □ PM

DASLP999

On a non-work or non-school day (i.e., weekend)?

____: ___

□ AM □ PM

About how many minutes does it usually take for you to fall asleep:

Minutes

DASLP999

On a workday or school day?

DASLP999

On a non-work or non-school day (i.e., weekend)?

At what time do you usually wake up:

Time

DASLP999

On a workday or school day?

______ : ______

□ AM □ PM

DASLP999

On a non-work or non-school day (i.e., weekend)?

______ : ______

□ AM □ PM

Minutes

Hours

DASLP999

How long does it take for you to become fully awake from regular sleep (i.e., after first opening your eyes in the morning)?

Never

Sometimes

Always

DASLP999

Do you use an alarm clock to wake up in the morning?

0

1

2

DASLP999

Do you have great difficulty waking up in the morning?

0

1

2

DASLP999

Do you often have so much trouble waking up that an alarm clock won't wake you and you have to use other methods to wake up?

Describe: ___________________________________________

___________________________________________

___________________________________________

0

1

2

DASLP999

When you wake up in the morning or from a nap, do you feel "out of it" and confused?

0

1

2

Hours

Minutes

DASLP999

How long does it take for you to fully awaken?

How much sleep do you usually get during a typical night:

Hours

Minutes

DASLP999-DASLP999

On a workday or school day?

DASLP999-DASLP999

On a non-work or non-school day (i.e., weekend)?

No

Yes

Unk

DASLP999

Do you usually follow the same sleep schedule (i.e., no more than a 1 hour difference in sleep and wake times) on both work/school and non-work/school days? (or school days and weekends)

0

1

9

Hours

DASLP999

How many hours of sleep per night do you think you need to feel fully rested the next day?

Never

Sometimes

Always

DASLP999

Do you feel awake and refreshed after sleeping?

0

1

2

Code Response

DASLP999

How often do you remember your dreams? That is, dreams that occur during your regular sleep and not while napping.

0

1

2

3

4

9

0 = Never

1 = Rarely (once a month or less)

2 = Sometimes (2-4 times per month)

3 = Often (5-15 times per month)

4 = Almost always (16-30 times per month)

9 = Don't Know

Naps

Code Response

DASLP999

How often do you take naps?

0

1

2

3

4

9

0 = Never

1 = Rarely (once a month or less)

2 = Sometimes (2-4 times per month)

3 = Often (5- 15 times per month)

4 = Almost Always (16-30 times per month)

9 = Don't know

If respondent never naps, SKIP to Sleep Deprivation.

Time

DASLP999

At what time(s) of the day do you usually take naps?

INTERVIEWER: List up to 3 time(s) of the day.

______ : ______

□ AM □ PM

DASLP999

______ : ______

□ AM □ PM

DASLP999

______ : ______

□ AM □ PM

Hours

Minutes

DASLP999-DASLP999

How many hours and minutes of sleep do you usually get when you take a nap?

Never

Sometimes

Always

DASLP999

Do you have great difficulty waking up from naps?

0

1

2

Code Response

DASLP999

How often do you dream when you nap?

0

1

2

3

4

9

0 = Never

1 = Rarely (once a month or less)

2 = Sometimes (2-4 times per month)

3 = Often (5-15 times per month)

4 = Almost always (16-30 times per month)

9 = Don't Know

No

Yes

Unk

DASLP999

Are these dreams very intense, detailed and vivid, like watching a movie?

0

1

9

Sleep Deprivation

Code Response

DASLP999

How difficult is it for you to adapt to a sleep loss of 3 hours or more (i.e. sleeping 3 or more hours less than you normally do the night before)?

0

1

2

3

9

0 = Not at all difficult

1 = Not very difficult

2 = Somewhat difficult

3 = Very difficult

9 = Don't know

INTERVIEWER: For the questions below, first determine whether sleep loss affects these factors. If there is a change following sleep loss, circle whether there is an improvement or a worsening, or an increase or decrease.

Does this loss of sleep affect you the next day with respect to…? (If yes, How?)

No

Yes

Circle One

DASLP999-DASLP999

…your mood (being sadder or happier)?

0

1

Improves

2

Worsens

3

Both

4

DK

9

DASLP999-DASLP999

…your tendency to be irritable?

0

1

Increases

2

Decreases

3

Both

4

DK

9

DASLP999-DASLP999

…your ability to get your work done?

0

1

Improves

2

Worsens

3

Both

4

DK

9

DASLP999-DASLP999

…how much you eat?

0

1

Increases

2

Decreases

3

Both

4

DK

9

DASLP999-DASLP999

…your desire for chocolate or sweets?

0

1

Increases

2

Decreases

3

Both

4

DK

9

Code Response

DASLP999

How quickly after this loss of sleep, do you return to your usual self if you are allowed to sleep as much as you like?

1

2

3

4

9

1 = Within 1 day or less

2 = 2 to 3 days

3 = 4 or 5 days

4 = Over 5 days

9 = Don't Know

Sleep Regularity

No

Yes

Unk

DASLP999

Do you prefer to keep a regular sleep schedule (i.e. one that does not change much from one night to the next)?

0

1

9

Code Response

DASLP999

If you do not keep your regular sleep schedule, how much do you feel "off" (i.e. not your regular self), the next day?

0

1

2

9

0 = None, Feel the Same

1 = Yes, Somewhat Off

2 = Yes, A Great Deal Off

9 = Don't Know

Jet Lag

Code Response

DASLP999

When you are traveling EAST by air and you cross over several time zones, how quickly do you return to your usual sleeping pattern?

1

2

3

4

7

9

1 = Within 1 day or less

2 = 2 to 3 days

3 = 4 or 5 days

4 = Over 5 days

7 = N/A

9 = Don't Know

DASLP999

What about when you are traveling WEST by air over several time zones?

Code same as above.

1

2

3

4

7

9

Morningness-Eveningness

Code Response

Neither

Type

Morning

Evening

DASLP999

Do you consider yourself to be a morning person ("early bird"), an evening person ("night owl"), or neither?

0

1

2

Code Response

None

Some

Strong

DASLP999

How strong is your preference?

0

1

2

DELAYED SLEEP PHASE SYNDROME

No

Yes

Unk

DASLP999

INTERVIEWER: Does respondent consistently fall asleep very late (i.e., 12 a.m. or later) at night AND characterize him/herself as a "night owl" with a "strong preference"?

0

1

9

If no, SKIP to Insomnia section

When you do not have to maintain a strict schedule (i.e. not dictated by strict work or school schedules, as while on vacation or not working):

Time

DASLP999

…at what time do you usually go to sleep (i.e. feel sleepy and ready to go to bed)?

______ : ______

□ AM □ PM

DASLP999

…at what time do you usually wake up?

______ : ______

□ AM □ PM

No

Yes

Unk

DASLP999

…are these usual sleep and wake times always about the same (i.e. each day during a week of vacation)?

0

1

9

DASLP999

…do you wake up on your own (i.e., without an alarm or other assistance)?

0

1

9

DASLP999

Have you ever tried to force yourself to fall asleep at an (earlier) time than your usual bedtime?

0

1

9

If no, SKIP to Insomnia Section.

DASLP999

When you tried to shift your sleep schedule to an earlier bedtime (at least 1 to 2 hours earlier), did you have difficulty falling asleep?

0

1

9

DASLP999

Do attempts to change your sleep/wake schedule tend to make your sleeping difficulties worse?

0

1

9

If no, SKIP to Insomnia Section.

Weeks

Months

Years

DASLP999-DASLP999

During the past year, what was the longest period of time that you had these sleeping problems on most nights?

If less than one month, SKIP to Insomnia.

EPISODES/COURSE

Onset

Age

DASLP999

How old were you when you first began going to sleep very late without being able to adjust your schedule when you tried?

DASLP999

Offset

How old were you the last time you experienced these problems?

No

Yes

Unk

DASLP999

Do you currently experience these problems?

0

1

9

DISTRESS/IMPAIRMENT

Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems.

Distress

Code Response

DASLP999

How much have your late bedtime and inability to adjust your schedule upset or distressed you?

Impairment

Code Response

DASLP999

Social

What number describes how much this eveningness tendency has affected your social life and/or relationships with your friends?

DASLP999

Family

What number describes how much this eveningness tendency has affected your relationships with family members?

DASLP999

School/Work

What number describes how much this eveningness tendency has affected your performance in school/work or your relationships with your co-workers, employers, teachers or classmates?

INSOMNIA (SIMPLE AND PSYCHOPHYSIOLOGIC)

Have you ever had frequent problems

No

Yes

Unk

DASLP999

1. getting to sleep at the beginning of the night…or

0

1

9

DASLP999

2. staying asleep at night…or

0

1

9

DASLP999

3. falling back to sleep after waking in the middle of the night…

...which has negatively affected how you function during the following day?

0

1

9

If no, SKIP to Narcolepsy-Cataplexy section.

In the past year, have you…?

DASLP999

…had difficulty getting to sleep?

0

1

9

DASLP999

…awakened during the night and had a hard time getting back to sleep?

0

1

9

DASLP999

…awakened too early in the morning and couldn't get back to sleep?

0

1

9

Weeks

Months

Years

DASLP999-DASLP999

What was the longest period of time you had sleeping problems (such as those described above) on most nights during the past year?

INTERVIEWER: If respondent endorses less than one month of sleeping problems, SKIP to Narcolepsy-Cataplexy section.

Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night:

No

Yes

Unk

DASLP999

Attention, concentration or memory problems?

0

1

9

DASLP999

Errors or accidents at work or while driving?

0

1

9

DASLP999

Social problems or poor work/school performance?

0

1

9

DASLP999

Fatigue?

0

1

9

DASLP999

Sleepiness?

0

1

9

DASLP999

Feeling tense/muscle tension?

0

1

9

DASLP999

Headaches?

0

1

9

DASLP999

Gastrointestinal symptoms (e.g. upset stomach, nervous stomach)?

0

1

9

DASLP999

Mood changes/problems or irritability?

0

1

9

DASLP999

A lack of motivation or energy to do things (manifested as e.g. procrastination or lack of initiative)?

0

1

9

DASLP999

Concerns or worries about sleep?

0

1

9

Do you do any of the following during the night when you cannot fall asleep, do you:

DASLP999

Experience frustration, tension and/or anxiety over not being able to go to sleep?

0

1

9

DASLP999

Look at the clock frequently to see how long you have not been able to fall asleep?

0

1

9

DASLP999

When you are NOT sleeping in your usual bed (e.g. in a hotel room while on vacation, or on your couch watching television), do you still have problems initially getting to sleep, staying asleep, or falling back to sleep after waking up during the night?

0

1

9

ASSOCIATED CONDITIONS

Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)?

No

Yes

Unk

DASLP999

…caffeine or other stimulant use?

0

1

9

DASLP999

…other drugs or medications?

0

1

9

Specify:__________________________________________

DASLP999

…changing schedule?

0

1

9

Specify:__________________________________________

DASLP999

…noisy or uncomfortable surroundings?

0

1

9

Specify:__________________________________________

DASLP999

…stress or major life event?

0

1

9

Specify:__________________________________________

DASLP999

…other disturbances (i.e. children, pets, etc.)?

0

1

9

Specify:__________________________________________

DASLP999

…an emotional or mental condition?

0

1

9

Specify:___________________________________

DASLP999

…other medical condition?

0

1

9

Specify:__________________________________________

DASLP999

Do you ever have trouble falling asleep or staying asleep, when there seems to be no cause or explanation for it?

0

1

9

Specify:__________________________________________

FOR WOMEN ONLY

Has your difficulty with sleeping occurred or worsened during any of the following conditions...

No

Yes

Unk

DASLP999

...pregnancy?

DASLP999

…menopause? (ask for women over 35)

DASLP999

…just before (a few days) menstruation?

DASLP999

…menstruation?

EPISODES/COURSE

Episodes

Number Episodes

DASLP999

How many separate times in your life have you had difficulty getting to sleep, staying asleep or falling back to sleep after waking up during the night (for at least one month)?

Age

DASLP999

Onset

How old were you when you first experienced this kind of difficulty with sleeping (for at least one month)?

DASLP999

Offset

How old were you the last time you experienced this insomnia (for at least one month)?

No

Yes

Unk

DASLP999

Do you currently experience insomnia?

0

1

9

Times per Week

DASLP999-DASLP999

How frequently do you experience insomnia?

DISTRESS/IMPAIRMENT

Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems.

Distress

Code Response

DASLP999

How much does your insomnia (sleep difficulties) upset or distress you?

Impairment

Code Response

DASLP999

Social

What number describes how much your insomnia has affected your social life or relationships with your friends?

Code Response

DASLP999

Family

What number describes how much your insomnia has affected your relationships with family members?

Code Response

DASLP999

School/Work

What number describes how much your insomnia has affected your performance in school/work or your relationships with your co-workers, employers, teachers or classmates?

NARCOLEPSY-CATAPLEXY

A. Daytime Sleepiness

No

Yes

Unk

DASLP999

1. Do you feel so sleepy during the day that it interrupts your normal activities – such as driving, reading, or concentrating at work or school, even when you have had enough sleep the night before?

0

1

9

Times per

Day

Week

Month

DASLP999-DASLP999

How often do you feel this way?

Weeks

Months

Years

DASLP999-DASLP999

What is the longest period of time that you have felt this way (on most days)?

No

Yes

Unk

DASLP999

2. During the daytime, do you experience an overwhelming desire to go to sleep – so overwhelming that you cannot resist?

0

1

9

Times per

Day

Week

Month

DASLP999-DASLP999

How often does this overwhelming desire to go to sleep occur?

Weeks

Months

Years

DASLP999-DASLP999

What is the longest period of time that you have felt this way (on most days)?

Never

Sometimes

Always

DASLP999

When you do doze off during the day and take a nap, do you find this sleep refreshing?

Describe:

___________________________________________

________________________________________ ________________________________________

0

1

2

Code Response

DASLP999

3. Do you feel that you are sleepier than other people your age?

0

1

2

9

0 = Not at all

1 = Somewhat

2 = A lot more sleepy

9 = Don't Know

B. Cataplexy

Do you ever experience periods of muscle weakness, loss of muscle strength or limp muscles in any part of your body (e.g. in the legs or face) during the following situations:

No

Yes

Unk

DASLP999

…when you laugh?

0

1

9

DASLP999

…when you are angry?

0

1

9

DASLP999

…when you hear or tell a joke?

0

1

9

REM SLEEP BEHAVIOR DISORDER

No

Yes

Unk

DASLP999

1. Have you ever been told that you "act out" your dreams?

0

1

9

Times per

Week

Month

Year

DASLP999-DASLP999

How often does this occur?

No

Yes

Unk

DASLP999

2. Do you ever move so much during your sleep that you accidentally hit your bed partner (if any) or hurt yourself?

0

1

9

If no to all (#1 and #2), SKIP to end

No

Yes

Unk

DASLP999

Do you have any memory of these event(s)?

0

1

9

DASLP999

Does moving at night disrupt your sleep? (i.e. wake you up at night)

0

1

9

First

Half

Second Half

DASLP999

During what part of the night do these events most often occur?

1

2

Protocol Name from Source:

Not applicable, see source.

Availability:

Publicly available

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews*. The interviewer should be trained to prompt respondents further if a "don't know" response is provided.

* There are multiple modes to administer this question (e.g., pencil and paper and computer-assisted interviews).

Equipment Needs

While the source protocol was developed to be administered by a computer-assisted instrument, the Psychiatric Working Group acknowledges these questions can be administered in a non-computerized format (i.e. pencil and paper instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire

Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Adult, Senior, Pregnancy

Participants:

Adult age 18 and older

Specific Instructions:

None

Selection Rationale

The National Institute of Mental Health (NIMH) Sleep Patterns and Problems was vetted against similar protocols and selected because it has been used in the National Institute of Mental Health Family Study and covers many areas of sleep disorders.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Sleep Disorder Assessment Score 3075469 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Sleep disorders screener proto 62742-2 LOINC
Derived Variables

None

Process and Review

Expert Review Panel 4 (ERP 4) reviewed the measures in the Neurology, Psychiatric, and Psychosocial domains. Guidance from ERP 4 included the following:

  • · No changes

Source

K R Merikangas, Branch Chief, Genetic Epidemiology Research Branch, National Institute of Mental Health

General References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: Author.

Protocol ID:

121001

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX121001_Act_Out_Dreams PX121001630000 Have you ever been told that you "act out" your dreams? 4 N/A
PX121001_Act_Out_Dreams_HowOften_Months PX121001630200 How often does this happen 4 N/A
PX121001_Act_Out_Dreams_HowOften_Weeks PX121001630100 How often does this happen 4 N/A
PX121001_Act_Out_Dreams_HowOften_Years PX121001630300 How often does this happen 4 N/A
PX121001_Adapt_Sleep_Loss_3hours PX121001190000 How difficult is it for you to adapt to a sleep loss of 3 hours or more (i.e. sleeping 3 or more hours less than you normally do the night before)? 4 N/A
PX121001_Age_First_Experience_Difficulty_Month PX121001470000 How old were you when you first experienced this kind of difficulty with sleeping (for at least one month)? 4 N/A
PX121001_Age_Last_Episode PX121001340000 How old were you the last time you experienced these problems? 4 N/A
PX121001_Age_Last_Experience_Difficulty_Month PX121001480000 How old were you the last time you experienced this insomnia (for at least one month)? 4 N/A
PX121001_Age_Sleep_Without_Adjusting_Schedule PX121001330000 How old were you when you first began going to sleep very late without being able to adjust your schedule when you tried? 4 N/A
PX121001_Alarm_Clock PX121001070100 Do you use an alarm clock to wake up in the morning? 4 N/A
PX121001_Amount_Sleep_Naptime_Hours PX121001160200 How many hours and minutes of sleep do you usually get when you take a nap? 4 N/A
PX121001_Amount_Sleep_Naptime_Minutes PX121001160100 How many hours and minutes of sleep do you usually get when you take a nap? 4 N/A
PX121001_Amount_Sleep_NonWorkday_Hours PX121001090302 How much sleep do you usually get during a typical night: On a non-work or non-school day (i.e., weekend)? 4 N/A
PX121001_Amount_Sleep_NonWorkday_Minutes PX121001090301 How much sleep do you usually get during a typical night: On a non-work or non-school day (i.e., weekend)? 4 N/A
PX121001_Amount_Sleep_Workday_Hours PX121001090202 How much sleep do you usually get during a typical night: On a workday or school day? 4 N/A
PX121001_Amount_Sleep_Workday_Minutes PX121001090201 How much sleep do you usually get during a typical night: On a workday or school day? 4 N/A
PX121001_Bedtime_Nonwork_Day PX121001030200 At what time do you usually go to bed: On a non-work or non-school day (i.e., weekend)? 4 N/A
PX121001_Bedtime_Nonwork_Day_AM_PM PX121001030201 AM or PM 4 N/A
PX121001_Bedtime_WorkDay PX121001030100 At what time do you usually go to bed: On a workday or school day? 4 N/A
PX121001_Bedtime_WorkDay_AM_PM PX121001030101 AM or PM 4 N/A
PX121001_Before_Menstruation PX121001450300 Has your difficulty with sleeping occurred or worsened during any of the following conditions... just before (a few days) menstruation? 4 N/A
PX121001_Caffeine PX121001430100 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...caffeine or other stimulant use? 4 N/A
PX121001_Changing_Schedule PX121001430300 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following? ...changing schedule? 4 N/A
PX121001_Changing_Schedules_Sleep_More_Difficult PX121001310000 Do attempts to change your sleep/wake schedule tend to make your sleeping difficulties worse? 4 N/A
PX121001_Changing_Schedule_Specify PX121001430301 Specify 4 N/A
PX121001_Currently_Experience_Problems PX121001350000 Do you currently experience these problems? 4 N/A
PX121001_Current_Insomnia PX121001490000 Do you currently experience insomnia? 4 N/A
PX121001_Daytime_Desire_To_Sleep PX121001580000 During the daytime, do you experience an overwhelming desire to go to sleep - so overwhelming that you cannot resist? 4 N/A
PX121001_Difficulties_Worried_About_Sleep PX121001410100 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Concerns or worries about sleep? 4 N/A
PX121001_Difficulty_Anxiety PX121001410200 Do you do any of the following during the night when you cannot fall asleep, do you: Experience frustration, tension and/or anxiety over not being able to go to sleep? 4 N/A
PX121001_Difficulty_Attention_Concentration PX121001400100 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Attention, concentration or memory problems? 4 N/A
PX121001_Difficulty_Errors_Accidents PX121001400200 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Errors or accidents at work or while driving? 4 N/A
PX121001_Difficulty_Fatigue PX121001400400 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Fatigue? 4 N/A
PX121001_Difficulty_Gastrointestinal PX121001400800 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Gastrointestinal symptoms (e.g. upset stomach, nervous stomach)? 4 N/A
PX121001_Difficulty_Headaches PX121001400700 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Headaches? 4 N/A
PX121001_Difficulty_Mood PX121001400900 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Mood changes/problems or irritability? 4 N/A
PX121001_Difficulty_Motivation PX121001401000 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: A lack of motivation or energy to do things (manifested as e.g. procrastination or lack of initiative)? 4 N/A
PX121001_Difficulty_Sleepiness PX121001400500 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Sleepiness? 4 N/A
PX121001_Difficulty_Social_Work PX121001400300 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Social problems or poor work/school performance? 4 N/A
PX121001_Difficulty_Tense PX121001400600 Do you experience any of the following during the daytime due to your difficulties falling asleep or staying asleep at night: Feeling tense/muscle tension? 4 N/A
PX121001_Difficulty_Waking_From_Naps PX121001170000 Do you have great difficulty waking up from naps? 4 N/A
PX121001_Difficulty_Waking_Up PX121001070200 Do you have great difficulty waking up in the morning? 4 N/A
PX121001_Distressed_Scale PX121001360100 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems. How much have your late bedtime and inability to adjust your schedule upset or distressed you? 4 N/A
PX121001_Dream_Nap PX121001180000 How often do you dream when you nap? 4 N/A
PX121001_During_Menstruation PX121001450400 Has your difficulty with sleeping occurred or worsened during any of the following conditions... menstruation? 4 N/A
PX121001_Emotional_Condition PX121001430700 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...an emotional or mental condition? 4 N/A
PX121001_Emotional_Condition_Specify PX121001430701 Specify 4 N/A
PX121001_Falling_Back_Asleep_Work_Problems PX121001370300 Have you ever had frequent problems falling back to sleep after waking in the middle of the nigh which has negatively affected how you function during the following day? 4 N/A
PX121001_Fall_Asleep_NonWorkday PX121001040200 About how many minutes does it usually take for you to fall asleep: On a non-work or non-school day (i.e., weekend)? 4 N/A
PX121001_Fall_Asleep_Workday PX121001040100 About how many minutes does it usually take for you to fall asleep: On a workday or school day? 4 N/A
PX121001_Feel_Refreshed PX121001120000 Do you feel awake and refreshed after sleeping? 4 N/A
PX121001_Follow_Same_Sleep_Schedule PX121001100000 Do you usually follow the same sleep schedule (i.e., no more than a 1 hour difference in sleep and wake times) on both work/school and non-work/school days? (or school days and weekends) 4 N/A
PX121001_Force_Self_Asleep_Early PX121001290000 Have you ever tried to force yourself to fall asleep at an (earlier) time than your usual bedtime? 4 N/A
PX121001_Force_Self_Asleep_Early_Difficulty PX121001300000 When you tried to shift your sleep schedule to an earlier bedtime (at least 1 to 2 hours earlier), did you have difficulty falling asleep 4 N/A
PX121001_Fully_Awaken_Nap_Hours PX121001090102 How long does it take for you to fully awaken? 4 N/A
PX121001_Fully_Awaken_Nap_Minutes PX121001090101 How long does it take for you to fully awaken? 4 N/A
PX121001_Getting_To_Sleep_Work_Problems PX121001370100 Have you ever had frequent problems getting to sleep at the beginning of the night which has negatively affected how you function during the following day? 4 N/A
PX121001_Hours_Sleep_Needed PX121001110000 How many hours of sleep per night do you think you need to feel fully rested the next day? 4 N/A
PX121001_HowOften_Desire_To_Sleep_Days PX121001580100 How often does this overwhelming desire to go to sleep occur? 4 N/A
PX121001_HowOften_Desire_To_Sleep_Months PX121001580300 How often does this overwhelming desire to go to sleep occur? 4 N/A
PX121001_HowOften_Desire_To_Sleep_Weeks PX121001580200 How often does this overwhelming desire to go to sleep occur? 4 N/A
PX121001_How_Often_Interrupt_Days PX121001560100 How often do you feel this way? 4 N/A
PX121001_How_Often_Interrupt_Months PX121001560300 How often do you feel this way? 4 N/A
PX121001_How_Often_Interrupt_Weeks PX121001560200 How often do you feel this way? 4 N/A
PX121001_How_Often_Take_Naps PX121001140000 How often do you take naps? 4 N/A
PX121001_Insomnia_Distress_Scale PX121001510000 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems. How much does your insomnia (sleep difficulties) upset or distress you? 4 N/A
PX121001_Insomnia_Family_Impairment_Scale PX121001530000 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems. What number describes how much your insomnia has affected your relationships with family members? 4 N/A
PX121001_Insomnia_Frequency PX121001500000 How frequently do you experience insomnia? 4 N/A
PX121001_Insomnia_Social_Impairment_Scale PX121001520000 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems. What number describes how much your insomnia has affected your social life or relationships with your friends? 4 N/A
PX121001_Insomnia_Work_Impairment_Scale PX121001540000 What number describes how much your insomnia has affected your performance in school/work or your relationships with your co-workers, employers, teachers or classmates? 4 N/A
PX121001_Interviewer_Morning_Evening PX121001270000 INTERVIEWER: Does respondent consistently fall asleep very late (i.e., 12 a.m. or later) at night AND characterize him/herself as a "night owl" with a "strong preference"? 4 N/A
PX121001_Jet_Lag_East PX121001240000 When you are traveling EAST by air and you cross over several time zones, how quickly do you return to your usual sleeping pattern 4 N/A
PX121001_Jet_Lag_West PX121001250000 What about when you are traveling WEST by air over several time zones? 4 N/A
PX121001_Last_Year_Longest_Period_Months PX121001320200 During the past year, what was the longest period of time that you had these sleeping problems on most nights? 4 N/A
PX121001_Last_Year_Longest_Period_Weeks PX121001320100 During the past year, what was the longest period of time that you had these sleeping problems on most nights? 4 N/A
PX121001_Last_Year_Longest_Period_Years PX121001320300 During the past year, what was the longest period of time that you had these sleeping problems on most nights? 4 N/A
PX121001_LongestPeriod_Desire_To_Sleep_Months PX121001590200 What is the longest period of time that you have felt this way (on most days)? 4 N/A
PX121001_LongestPeriod_Desire_To_Sleep_Weeks PX121001590100 What is the longest period of time that you have felt this way (on most days)? 4 N/A
PX121001_LongestPeriod_Desire_To_Sleep_Years PX121001590300 What is the longest period of time that you have felt this way (on most days)? 4 N/A
PX121001_Longest_Period_Months_Interrupt PX121001570200 What is the longest period of time that you have felt this way (on most days)? 4 N/A
PX121001_Longest_Period_Weeks_Interrupt PX121001570100 What is the longest period of time that you have felt this way (on most days)? 4 N/A
PX121001_Longest_Period_Years_Interrupt PX121001570300 What is the longest period of time that you have felt this way (on most days)? 4 N/A
PX121001_Look_At_Clock PX121001410300 Do you do any of the following during the night when you cannot fall asleep, do you: Look at the clock frequently to see how long you have not been able to fall asleep? 4 N/A
PX121001_Loss_Of_Sleep_Recovery PX121001210000 How quickly after this loss of sleep, do you return to your usual self if you are allowed to sleep as much as you like? 4 N/A
PX121001_Memory_Move_In_Sleep PX121001650000 Do you have any memory of these event(s)? 4 N/A
PX121001_Menopause PX121001450200 Has your difficulty with sleeping occurred or worsened during any of the following conditions... menopause? (ask for women over 35) 4 N/A
PX121001_Methods_Besides_Alarm PX121001070300 Do you often have so much trouble waking up that an alarm clock won't wake you and you have to use other methods to wake up? 4 N/A
PX121001_Methods_Besides_Alarm_Describe PX121001070301 Describe 4 N/A
PX121001_Morning_Evening_Preference PX121001260100 How strong is your preference? 4 N/A
PX121001_Morning_Or_Evening_Person PX121001260000 Do you consider yourself to be a morning person ("early bird"), an evening person ("night owl"), or neither? 4 N/A
PX121001_Move_In_Sleep PX121001640000 Do you ever move so much during your sleep that you accidentally hit your bed partner (if any) or hurt yourself? 4 N/A
PX121001_Move_Which_Half_Of_Night PX121001670000 During what part of the night do these events most often occur 4 N/A
PX121001_Moving_Disrupt_Sleep PX121001660000 Does moving at night disrupt your sleep? (i.e. wake you up at night) 4 N/A
PX121001_Muscle_Weakness_Angry PX121001620200 Do you ever experience periods of muscle weakness, loss of muscle strength or limp muscles in any part of your body (e.g. in the legs or face) during the following situations: ...when you are angry? 4 N/A
PX121001_Muscle_Weakness_Joke PX121001620300 Do you ever experience periods of muscle weakness, loss of muscle strength or limp muscles in any part of your body (e.g. in the legs or face) during the following situations: ...when you hear or tell a joke? 4 N/A
PX121001_Muscle_Weakness_Laugh PX121001620100 Do you ever experience periods of muscle weakness, loss of muscle strength or limp muscles in any part of your body (e.g. in the legs or face) during the following situations: ...when you laugh? 4 N/A
PX121001_Naptime1 PX121001150100 At what time(s) of the day do you usually take naps? 4 N/A
PX121001_Naptime1_AM_PM PX121001150101 AM or PM 4 N/A
PX121001_Naptime2 PX121001150200 At what time(s) of the day do you usually take naps? 4 N/A
PX121001_Naptime2_AM_PM PX121001150201 AM or PM 4 N/A
PX121001_Naptime3 PX121001150300 At what time(s) of the day do you usually take naps? 4 N/A
PX121001_Naptime3_AM_PM PX121001150301 AM or PM 4 N/A
PX121001_Nap_Dreams_Intense PX121001180100 Are these dreams very intense, detailed and vivid, like watching a movie? 4 N/A
PX121001_Nap_Refreshing PX121001600000 When you do doze off during the day and take a nap, do you find this sleep refreshing? 4 N/A
PX121001_Nap_Refreshing_Describe PX121001600100 When you do doze off during the day and take a nap, do you find this sleep refreshing? Describe 4 N/A
PX121001_Noisy_Surroundings PX121001430400 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...noisy or uncomfortable surroundings? 4 N/A
PX121001_Noisy_Surroundings_Specify PX121001430401 Specify 4 N/A
PX121001_Normal_Schedule PX121001020100 What is your normal work (or school) and sleep schedule? 4 N/A
PX121001_Normal_Schedule_Other_Describe PX121001020101 What is your normal work (or school) and sleep schedule? Other, Describe 4 N/A
PX121001_No_Explanation PX121001440000 Do you ever have trouble falling asleep or staying asleep, when there seems to be no cause or explanation for it? 4 N/A
PX121001_No_Explanation_Specify PX121001440100 Specify 4 N/A
PX121001_No_Sleep_Schedule_Feel_Off PX121001230000 If you do not keep your regular sleep schedule, how much do you feel "off" (i.e. not your regular self), the next day? 4 N/A
PX121001_Number_Times_Experience_Difficulty PX121001460000 How many separate times in your life have you had difficulty getting to sleep, staying asleep or falling back to sleep after waking up during the night (for at least one month)? 4 N/A
PX121001_Other_Disturbances PX121001430600 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...other disturbances (i.e. children, pets, etc.)? 4 N/A
PX121001_Other_Disturbances_Specify PX121001430601 Specify 4 N/A
PX121001_Other_Drugs PX121001430200 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...other drugs or medications? 4 N/A
PX121001_Other_Drugs_Specify PX121001430201 Specify 4 N/A
PX121001_Other_Medical_Condition PX121001430800 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...other medical condition? 4 N/A
PX121001_Other_Medical_Condition_Specify PX121001430801 Specify 4 N/A
PX121001_Past_Year_Awakened_Middle_Night PX121001380200 In the past year, have you awakened during the night and had a hard time getting back to sleep? 4 N/A
PX121001_Past_Year_Difficulty_Falling_Asleep PX121001380100 In the past year, have you had difficulty getting to sleep? 4 N/A
PX121001_Past_Year_Longest_Period_Months PX121001390200 What was the longest period of time you had sleeping problems (such as those described above) on most nights during the past year? 4 N/A
PX121001_Past_Year_Longest_Period_Weeks PX121001390100 What was the longest period of time you had sleeping problems (such as those described above) on most nights during the past year? 4 N/A
PX121001_Past_Year_Longest_Period_Years PX121001390300 What was the longest period of time you had sleeping problems (such as those described above) on most nights during the past year? 4 N/A
PX121001_Past_Year_Wake_Up_Early PX121001380300 In the past year, have you awakened too early in the morning and couldn't get back to sleep? 4 N/A
PX121001_Prefer_Regular_Sleep_Schedule PX121001220000 Do you prefer to keep a regular sleep schedule (i.e. one that does not change much from one night to the next)? 4 N/A
PX121001_Pregnancy PX121001450100 Has your difficulty with sleeping occurred or worsened during any of the following conditions... pregnancy? 4 N/A
PX121001_Relationship_Distress_Scale PX121001360300 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems.What number describes how much this eveningness tendency has affected your relationships with family members? 4 N/A
PX121001_Remember_Dreams PX121001130000 How often do you remember your dreams? That is, dreams that occur during your regular sleep and not while napping 4 N/A
PX121001_Similar_Wake_Sleep_Times_Vacation PX121001280300 When you do not have to maintain a strict schedule (i.e. not dictated by strict work or school schedules, as while on vacation or not working): ...are these usual sleep and wake times always about the same (i.e. each day during a week of vacation)? 4 N/A
PX121001_Sleepier_Than_Others PX121001610000 Do you feel that you are sleepier than other people your age? 4 N/A
PX121001_Sleepy_Interrupt_Day PX121001550000 Do you feel so sleepy during the day that it interrupts your normal activities - such as driving, reading, or concentrating at work or school, even when you have had enough sleep the night before? 4 N/A
PX121001_Sleep_Loss_Affect_Eating PX121001200400 Does this loss of sleep affect you the next day with respect to...? how much you eat? 4 N/A
PX121001_Sleep_Loss_Affect_EatingSweets_How PX121001200501 Does this loss of sleep affect you the next day with respect to...? your desire for chocolate or sweets? (If yes, How?) 4 N/A
PX121001_Sleep_Loss_Affect_Eating_How PX121001200401 Does this loss of sleep affect you the next day with respect to...? how much you eat? (If yes, How?) 4 N/A
PX121001_Sleep_Loss_Affect_Eating_Sweets PX121001200500 Does this loss of sleep affect you the next day with respect to...? your desire for chocolate or sweets? 4 N/A
PX121001_Sleep_Loss_Affect_Irritable PX121001200200 Does this loss of sleep affect you the next day with respect to...? your tendency to be irritable? 4 N/A
PX121001_Sleep_Loss_Affect_Irritable_How PX121001200201 Does this loss of sleep affect you the next day with respect to...? your tendency to be irritable? (If yes, How?) 4 N/A
PX121001_Sleep_Loss_Affect_Mood PX121001200100 Does this loss of sleep affect you the next day with respect to...? your mood (being sadder or happier)? 4 N/A
PX121001_Sleep_Loss_Affect_Mood_How PX121001200101 Does this loss of sleep affect you the next day with respect to...? your mood (being sadder or happier)? (If yes, How?) 4 N/A
PX121001_Sleep_Loss_Affect_Work PX121001200300 Does this loss of sleep affect you the next day with respect to...? your ability to get your work done? 4 N/A
PX121001_Sleep_Loss_Affect_Work_How PX121001200301 Does this loss of sleep affect you the next day with respect to...? your ability to get your work done? (If yes, How?) 4 N/A
PX121001_Sleep_Time_Vacation PX121001280100 When you do not have to maintain a strict schedule (i.e. not dictated by strict work or school schedules, as while on vacation or not working): ...at what time do you usually go to sleep (i.e. feel sleepy and ready to go to bed)? 4 N/A
PX121001_Sleep_Time_Vacation_Am_Pm PX121001280101 AM or PM 4 N/A
PX121001_Social_Distress_Scale PX121001360200 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems. What number describes how much this eveningness tendency has affected your social life and/or relationships with your friends? 4 N/A
PX121001_Staying_Asleep_Work_Problems PX121001370200 Have you ever had frequent problems staying asleep at night which has negatively affected how you function during the following day? 4 N/A
PX121001_Stress_Major_Life_Event PX121001430500 Does your difficulty with insomnia occur at the same time as any of the following events or conditions (i.e. is the insomnia associated temporally with any of the following)? ...stress or major life event? 4 N/A
PX121001_Stress_Major_Life_Event_Specify PX121001430501 Specify 4 N/A
PX121001_Time_To_Wake_Up_Hours PX121001060200 How long does it take for you to become fully awake from regular sleep (i.e., after first opening your eyes in the morning)? 4 N/A
PX121001_Time_To_Wake_Up_Minutes PX121001060100 How long does it take for you to become fully awake from regular sleep (i.e., after first opening your eyes in the morning)? 4 N/A
PX121001_Unusual_Bed_Difficulty PX121001420000 When you are NOT sleeping in your usual bed (e.g. in a hotel room while on vacation, or on your couch watching television), do you still have problems initially getting to sleep, staying asleep, or falling back to sleep after waking up during the night? 4 N/A
PX121001_Wake_On_Own_Vacation PX121001280400 When you do not have to maintain a strict schedule (i.e. not dictated by strict work or school schedules, as while on vacation or not working): ...do you wake up on your own (i.e., without an alarm or other assistance)? 4 N/A
PX121001_Wake_Time_Vacation PX121001280200 When you do not have to maintain a strict schedule (i.e. not dictated by strict work or school schedules, as while on vacation or not working): ...at what time do you usually wake up 4 N/A
PX121001_Wake_Time_Vacation_AM_PM PX121001280201 AM or PM 4 N/A
PX121001_Wake_Up_NonWorkDay PX121001050200 At what time do you usually wake up:On a non-work or non-school day (i.e., weekend)? 4 N/A
PX121001_Wake_Up_NonWorkDay_AM_PM PX121001050201 AM or PM 4 N/A
PX121001_Wake_Up_Workday PX121001050100 At what time do you usually wake up: On a workday or school day? 4 N/A
PX121001_Wake_Up_Workday_AM_PM PX121001050101 AM or PM 4 N/A
PX121001_Waking_Up_Confused PX121001080000 When you wake up in the morning or from a nap, do you feel "out of it" and confused? 4 N/A
PX121001_Which_Shift PX121001020200 What shift schedule do you most often work? 4 N/A
PX121001_Work_Distress_Scale PX121001360400 Please look at this scale from 0 to 10, where 0 means no distress/impairment and 10 means very severe problems. What number describes how much this eveningness tendency has affected your performance in school/work or your relationships with your co-workers, employers, teachers or classmates? 4 N/A
PX121001_Work_During_Day PX121001010000 Do you normally work (or attend school) during the day and sleep at night? 4 N/A
Research Domain Information
Measure Name:

Sleep Disorders Screener

Release Date:

May 12, 2010

Definition

A questionnaire to assess sleep disorders, a broad group of disorders that can be caused by endogenous disturbances in the sleep-wake or timing cycles (APA, 2000).

Purpose

This measure is used to screen an individual for the presence of sleep disorders. Sleep disorders are comorbid with a wide variety of health conditions. For example, sleep abnormalities are commonly reported in conjunction with most mental disorders and are also often associated either with a general medical condition or medications used to treat a condition. Additionally, some sleep disorders, such as predisposition toward light, demonstrate a familial pattern indicating a genetic and/or environmental cause (APA, 2000).

Keywords

Sleep, sleep disorders, narcolepsy, sleepiness, routine sleep, insomnia, cataplexy, National Institute of Mental Health, NIMH, National Institute of Mental Health Sleep Patterns and Problems, Psychiatric