QuestionPro : Sleep Deprivation Questionnaire

Questions marked with a * are required

For questions 1-8: How likely are you to doze off or fall asleep in the following situations in contrast to feeling just tired? 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. These questions have been obtained from the Epworth Sleepiness Scale. [Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14, 540-545.]
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* Question 1 of 16: Sitting and reading

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 2 of 16: Watching TV

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 3 of 16: Sitting, inactive in a public place (e.g., a theater or meeting)

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 4 of 16: As a passenger in a car for an hour without a break

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 5 of 16: Lying down to rest in the afternoon when circumstances permit

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 6 of 16: Sitting and talking to someone

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 7 of 16: Sitting quietly after a lunch without alcohol

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 8 of 16: In a car, while stopped for a few minutes in traffic

Would never doze

Slight chance of dozing

Moderate chance of dozing

High chance of dozing

* Question 9 of 16: How many hours of sleep per night do you average?

* Question 10 of 16: What are the numbers of hours you spend per week at your clinical site?

* Question 11 of 16: What are the numbers of hours per week you spend studying, at lectures/meetings, etc.?

* Question 12 of 16: How many days of vacation does your program allow?

* Question 13 of 16: What is your current GPA?

Question 14 of 16: How does sleepiness affect your clinical and didactic performance as a nurse anesthesia student?

Question 15 of 16: If you are experiencing sleepiness, what do you feel are the causes?

Question 16 of 16: What can be introduced into your nurse anesthesia program to improve the negative effects of sleep deprivation in your clinical and didactic experiences?