Naturalistic Driving Study: Technical Coordination and Quality Control (2014) / Chapter Skim
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Pages 107-134
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107 A p p e n d i x B Sleep Questionnaire
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108 Sleep Questionnaire There are 80 questions in this survey SLEEP 1 1 What is your current work status? (Choose all that apply)
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109 -- -- -- -- or Scenario 2 -- -- -- -Answer was at question '1 [1] ' (What is your current work status?
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110 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM 4 On days you are working outside of the home, what time do you usually wake up? Only answer this question if the following conditions are met: ° -- -- -- -- Scenario 1 -- -- -- -Answer was at question '1 [1]
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111 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM NOON 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM 5 On days you are working from home, are your sleep habits: Only answer this question if the following conditions are met: °
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112 -- -- -- -- Scenario 1 -- -- -- -Answer was at question '1 [1] ' (What is your current work status?
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113 10:00 AM 10:30 AM 11:00 AM 11:30 AM NOON 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM 7 On days you are working from home, what time do you usually wake up? Only answer this question if the following conditions are met: ° -- -- -- -- Scenario 1 -- -- -- -Answer was at question '1 [1]
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114 Midnight 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM NOON 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM
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115 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM 8 Do you keep a fairly regular sleep schedule? Please choose only one of the following: Yes No 9 On average, how much sleep do you get in 24 hours on days when you are working?
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116 10 On average, how much sleep do you get in 24 hours on days when you are not working? Please write your answer(s)
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117 Rarely Never 15 On average, how long do your naps last? Only answer this question if the following conditions are met: ° Answer was greater than 'Never' at question '14 [12]
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118 19 In the LAST WEEK, on average, how many servings of caffeine did you consume per 24 hour period? Please choose only one of the following: None 1/2 serving per day 1-2 servings per day 3-4 servings per day 5-6 servings per day 7-8 servings per day More than 8 servings per day Count: 12 ounces of cola as 1/2 serving 8 ounces of energy drink as 1 serving 8 ounces of tea as 1/2 serving 8 ounces of home brew coffee as 1 serving 1 shot of espresso as 1 servings 1 Grande Starbucks as 3 servings 1 dose of NoDoz or Vivarin as 2 servings 1 dose of medicine containing caffeine as 1 serving
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119 20 In a TYPICAL WEEK, on average, how many servings of caffeine do you consume per 24 hour period? Please choose only one of the following: None 1/2 serving per day 1-2 servings per day 3-4 servings per day 5-6 servings per day 7-8 servings per day More than 8 servings per day Count: 12 ounces of cola as 1/2 serving 8 ounces of energy drink as 1 serving 8 ounces of tea as 1/2 serving 8 ounces of home brew coffee as 1 serving 1 shot of espresso as 1 servings 1 Grande Starbucks as 3 servings 1 dose of NoDoz or Vivarin as 2 servings 1 dose of medicine containing caffeine as 1 serving 21 In the LAST WEEK what is the pattern of your caffeine consumption?
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120 1-2 servings per week 3-5 servings per week 6-7 servings per week 8-14 servings per week more than 14 servings per week One serving equals: 1 glass, bottle, or can of beer 4 ounces of wine 1 mixed drink or shot of liquor 24 In a TYPICAL WEEK how many alcoholic beverages do you consume? Please choose only one of the following: None 1-2 servings per week 3-5 servings per week 6-7 servings per week 8-14 servings per week more than 14 servings per week One serving equals: 1 glass, bottle, or can of beer 4 ounces of wine 1 mixed drink or shot of liquor 25 Do you use tobacco products (e.g., smoke cigarettes, cigars, or a pipe or chew or snuff tobacco)
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121 27 Have you used any sleep aids in the LAST MONTH? Please choose only one of the following: Yes, regularly Yes, intermittently (i.e.
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122 30 In the LAST MONTH, what was the number of times that you have been awake in the following categories: Please write your answer(s) here: Awake 30 or more continuous hours: Awake 24 or more continuous hours (but less than 30 hours)
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123 Over 18 years: 35 In the LAST MONTH, how often have you been awakened in the night by any of your children? Only answer this question if the following conditions are met: ° Answer was 'Yes' at question '33 [34]
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124 Please use the following definitions as a guide for the questions below: Day shift: occurs anytime between 6am and 7pm Evening shift: occurs anytime between 3 pm and midnight Night shift: is any 8-10 hour shift between approximately 10pm and 8am or any 12 hour shift between approximately 7pm and 9am If your work schedule doesn't exactly fit into one of these categories, please use the shift category that most closely resembles your shift. To your best recollection: Please describe your activity during each week.
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125 42 For the PAST WEEK, was this week typical for you? Please choose only one of the following: Yes No 43 For the week, the PAST WEEK, why wasn't this week typical for you?
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126 vacation, sick days, and other full days off) ; Please write your answer here: 47 For the week, TWO WEEKS AGO, was this week typical for you?
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127 Hours spent working (include all time working at your regular job, overtime, second job, etc.) : {NOT EMPTY} Hours of sleep (Sum hours of sleep for all seven days of the week)
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128 54 For the week, FOUR WEEKS AGO, select all of the activities that apply: Please choose all that apply: Not working Day shift Evening shift Night shift Other, (please specify) : 55 For the week FOUR WEEKS AGO: Please write your answer(s)
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129 59 In the LAST MONTH, what was the greatest number of continuous hours you worked? Please write your answer here: (Consider hours continuous even if there was a break of up to 4 hours.
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130 No chance of dozing Slight chance of dozing Moderate chance of dozing High chance of dozing Sitting and talking to someone: In a car, while stopped for a few minutes in traffic: While at work during a night shift: While at work during a day or evening shift: This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you.
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131 Rarely Never Don't know 65 Have you been told that your snoring ever bothered other people? Only answer this question if the following conditions are met: ° Answer was 'Yes' at question '62 [62]
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132 Rarely Never 69 During my waking hours, I feel tired or fatigued Please choose only one of the following: Nearly every day 3-4 times per week 1-2 times per week 1-2 times per month Rarely Never 70 I have nodded off or fallen asleep while driving a vehicle. Please choose only one of the following: Yes No 71 If you have nodded off or fallen asleep while driving a vehicle, how often does this occur?
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133 72 This scale is intended to record your own assessment of any sleep difficulty you might have experienced. For each of the following questions, please select the answer that describes your sleep experiences/difficulties that have occurred AT LEAST 3 TIMES PER WEEK during the PAST MONTH.
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134 Very insufficient or did not sleep at all 77 Overall quality of sleep (no matter how long you slept) Please choose only one of the following: Satisfactory Slightly unsatisfactory Markedly unsatisfactory Very unsatisfactory or did not sleep at all 78 Sense of well-being during the time you are awake Please choose only one of the following: Normal Slightly decreased Markedly decreased Very decreased 79 Functioning (physical and mental)
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