Sleep History

SLEEP SCHEDULE: - Typical bedtime: 8:30 PM - Typical wake time: 6:30 AM - Naps (frequency, duration, timing): Occasionally, 30 minutes in the afternoon - Variability in sleep schedule: Consistent on weekdays, later bedtime on weekends SLEEP ENVIRONMENT: - Bedroom setup (bed, pillows, blankets): Comfortable bed with two pillows and a light blanket - Noise level: Quiet - Light exposure: Blackout curtains used - Temperature: Cool, around 20°C - Electronics in bedroom: No electronics allowed SLEEP HYGIENE: - Pre-bedtime routine: Reading a book for 30 minutes - Caffeine intake (amount, timing): No caffeine intake - Alcohol intake (amount, timing): Not applicable - Exercise (type, duration, timing): Plays soccer for 1 hour in the afternoon - Screen time before bed: Limited to 15 minutes SLEEP ONSET: - Time to fall asleep: 15 minutes - Difficulty falling asleep: Occasionally - Thoughts or worries when trying to sleep: None reported - Restlessness or discomfort: None SLEEP MAINTENANCE: - Number of awakenings per night: 1-2 times - Duration of awakenings: 5-10 minutes - Ability to fall back asleep: Easily - Reasons for awakenings: Occasionally needs to use the bathroom SLEEP QUALITY: - Feeling rested upon awakening: Usually - Daytime sleepiness or fatigue: Rarely - Concentration or memory difficulties: None - Mood disturbances: None SLEEP BEHAVIORS: - Snoring: None - Gasping or choking: None - Witnessed apneas: None - Restless legs or periodic limb movements: None - Sleep talking or sleepwalking: None - Nightmares or night terrors: Occasionally - Sleep paralysis: None - Teeth grinding (bruxism): None PREVIOUS SLEEP STUDIES: - Type of study (e.g. polysomnogram, MSLT): Not applicable - Date and location: Not applicable - Results and diagnosis: Not applicable MEDICATIONS: - Current medications for sleep: None - Past medications tried for sleep: None - Other medications that may impact sleep: None MEDICAL HISTORY: - Conditions that may impact sleep (e.g. chronic pain, GERD, asthma): Asthma - Psychiatric history (e.g. anxiety, depression): None - Neurologic history (e.g. restless legs syndrome, narcolepsy): None FAMILY HISTORY: - Family members with sleep disorders: Father has sleep apnea - Family members with psychiatric or neurologic conditions: None SOCIAL HISTORY: - Work schedule (shift work, irregular hours): Not applicable - Living situation and bed partner: Lives with parents, no bed partner - Travel and jet lag: None recently OTHER NOTES: - None