MorningQ

Our Sleep Specialist requires the below information to complete the review and scoring of your sleep study.

We ask for your help by completing these questions when you packup your sleep machine.

First Name *

Surname *

What time did you get into bed ? *

How long do you think it took you to fall asleep ? *

Did any of the eletrodes or sensors fall off during the night ? *

YesNo

If YES to the above, do you know which one(s) ?

Did you drink any alcohol last evening before the Sleep Study? *

NoYes - 1 or 2Yes - 2 to 4Yes - More

Dod you take any medications to help you sleep ? *

YesNo

If YES to Sleep Medications, which one(s) ?

What time did you wake up this morning ? *

Did anything disturb your sleep last night ? What was it ?

How would you describe your sleep last night ? *

PoorGoodVery Good

How would you compare this sleep to normal ? *

WorseSameBetter (than usual)

Is there anything else you would like us to know?