Inpatient PSG Morning Questionnaire

Patient Name

Title

First name

Middle name

Surname

Maiden name (if applicable)

Date of Birth (DD/MM/YYYY)

Morning Questionnaire

In general, how well do you feel you slept last night when compared to your usual nights sleep?

How long do you believe it took you to fall asleep last night?

How long did it take you to fall asleep last night, when compared with a normal night?

How many times do you believe you woke from your sleep?

What disturbed your sleep last night? (Please tick as many as applicable)

Needing the bathroom

How many times?

Pain

Please describe the pain:

Discomfort

Please describe the discomfort:

Noise

Please describe the noise:

Disturbance from Technician

Please describe:

Other

Please describe disturbance:

How did you feel when you woke this morning?

Please add any additional comments related to your sleep:

Please rate the service you received between 0-5 (5 being the best score)

012345

Please add any additional comments about the service:

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