Patient Instructions for Sleep Study
_______________________________: Your appointment has been scheduled for ___________________
at the sleep lab located at the Altru Hospital. Please register at Altru Hospital Front Lobby at
____________ p.m. unless your appointment falls on a Sunday, then go to the Emergency entrance
located on the north side of the hospital and register at their registration desk.
Please follow these instructions to ensure good conditions for the study on the day of your Sleep
Study appointment.
1.
Upon completing the Sleep Log Report and Questionnaire, please bring it with you on the day of your
study. Try to do the Sleep Study Log report the two weeks before your study if possible.
2.
Do not drink any caffeine beverages such as coffee, tea, or cola products (e.g., Coke, Pepsi, Dr. Pepper)
after 12:00 noon on the day of your appointment or 6 hours before your usual bedtime.
3.
Do not drink any alcoholic beverages, including beer, liquors, brandy, or any wines, after 12:00 noon on
the day of your appointment. If you normally consume alcohol on a regular basis, please call us for
instructions.
4.
You may take your regular medications such as blood pressure pills, heart pills, etc., PLEASE BRING
ALL MEDICATIONS WITH YOU.
4.
Before you come to the lab for your study, bathe and shampoo your hair. Do not use any hair conditioners, creams, oils, or dressings on your hair after you shampoo. Do not use any makeup, skin creams, or
conditions on your face after you wash it.
6.
Bring nightclothes (pajamas or nightgown, bathrobe, slippers).
7.
Bring items you may need to wash and dress with in the morning (toothbrush, shaving equipment,
shampoo, clothes, etc.)
8.
You may bring your favorite pillow, if you wish, as well as reading materials.
9.
If you need to get up in the morning by a certain time, please tell the technician. You do not need to
bring an alarm clock. Usual wake up time is between 6:00 - 6:30 a.m.
10. If you have any questions, please call the Sleep Laboratory. If for some reason you are
running late or have to cancel your appointment, please call the laboratory and let us know, at
701-780-5484.
Thank you,
Sleep Laboratory Technologist
Altru Health System
Page 1
6012-1930 FEB 06
Sleep Log Report
WEEK 1
Name
Use these symbols:
Lights OUT or in bed trying to sleep
I______I Asleep
Fill out
about
5 p.m.
Fill out in the Morning
Lights ON or out of be for the day
C Caffeinated coffee or soda
Day &
How
Date
much
PM
Midnight
AM
Noon
PM (at noon) sleep?
6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6
Sleeping aid, alcohol,
medicine?
Time, type & amount
Sleep
Quality
Daytime
Fatigue?
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Page 2
Day &
How
Example:
Date
much
PM
Midnight
AM
Noon
PM
6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 (at noon) sleep?
C
TH 3/9
7¼ hrs
Sleeping aid, alcohol,
medicine?
Time, type & amount
Sleep
Quality
Daytime
Fatigue?
Ambien 10 p.m.
Low
Med
Sleep Log Report
WEEK 2
Name
Use these symbols:
Lights OUT or in bed trying to sleep
I______I Asleep
Fill out
about
5 p.m.
Fill out in the Morning
Lights ON or out of be for the day
C Caffeinated coffee or soda
Day &
How
Date
much
PM
Midnight
AM
Noon
PM (at noon) sleep?
6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6
Sleeping aid, alcohol,
medicine?
Time, type & amount
Sleep
Quality
Daytime
Fatigue?
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Hi Med Low Hi Med Low
Page 3
Day &
How
Example:
Date
much
PM
Midnight
AM
Noon
PM
6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 (at noon) sleep?
C
TH 3/9
7¼ hrs
Sleeping aid, alcohol,
medicine?
Time, type & amount
Sleep
Quality
Daytime
Fatigue?
Ambien 10 p.m.
Low
Med