9 Not asked. SLEEP SECTION Q201 Have you had any trouble sleeping Q201 This item refers to any type of sleep recently? disturbance which R has noticed. If R has 0. No trouble/no change in pattern recently been admitted to an institution, 1. Yes sleep performance should be assessed on 8. No answer the one month prior to admission. 9. Not asked IF YES ASK Q202, OTHERWISE SKIP TO Q211 Q202 Have you taken anything to help you Q202 Rate here for the use of medication sleep? Does it help? or alcohol to aid sleep. Medication refers to specific sleeping tablets or certain 0. Not taken anything sedatives which are being used for the 1. Mild/Infrequent problems despite purpose of inducing or assisting the onset 2. Severe/Persistent problems despite of sleep. 3. Taken & no problems 8. No answer 9. Not asked Q203 How long has it been going on for? Q203 Rate for excessive sleep if R feels What used to happen? the need for several hours more sleep a night than usual and probably awakens the 0. No persistent problem next morning still feeling tired. 1. Mild marked insomnia Rate most nights for at two weeks in 2. Severe marked insomnia the last month. 3. Mild marked excessive 4. Severe marked excessive sleep 8. No answer 9. Not asked 204 RATE HAS INSOMNIA MOST 204 Rate here a reversal of sleep pattern OF THE NIGHT AND SLEEPS MAINLY whereby R lies awake most of the night or DURING THE DAY (If not established fails to go to bed and sleeps mainly during ASK When do you get any sleep?) the day time. 0. No 1. Infrequent 2. Frequent/Persistent 8. No answer 9. Not asked
9 Not asked. SLEEP SECTION Q201 Have you had any trouble sleeping recently? 0. No trouble/no change in pattern 1. Yes 8. No answer 9. Not asked Q201 This item refers to any type of sleep disturbance which R has noticed. If R has recently been admitted to an institution, sleep performance should be assessed on the one month prior to admission. IF YES ASK Q202, OTHERWISE SKIP TO Q211 Q202 Have you taken anything to help you sleep? Does it help? 0. Not taken anything 1. Mild/Infrequent problems despite 2. Severe/Persistent problems despite 3. Taken & no problems 8. No answer 9. Not asked Q202 Rate here for the use of medication or alcohol to aid sleep. Medication refers to specific sleeping tablets or certain sedatives which are being used for the purpose of inducing or assisting the onset of sleep. Q203 How long has it been going on for? What used to happen? 0. No persistent problem 1. Mild marked insomnia 2. Severe marked insomnia 3. Mild marked excessive 4. Severe marked excessive sleep 8. No answer 9. Not asked Q203 Rate for excessive sleep if R feels the need for several hours more sleep a night than usual and probably awakens the next morning still feeling tired. Rate most nights for at two weeks in the last month. 204 RATE HAS INSOMNIA MOST OF THE NIGHT AND SLEEPS MAINLY DURING THE DAY (If not established ASK When do you get any sleep?) 0. No 1. Infrequent 2. Frequent/Persistent 8. No answer 9. Not asked 204 Rate here a reversal of sleep pattern whereby R lies awake most of the night or fails to go to bed and sleeps mainly during the day time.
CFAS-II-questionnaire-part-1-v5-1110081.docx