Date:   November 25, 2002                                                                                        DAY 3

0100-0159

0200-0259

0300

0359

0400-0459

0500-

0559

0600-0659

0700-0759

0800-0859

0900-0959

1000-1059

1100-1159

1200-1259

H20

0315 cig 1 coffee

6 oz

H20

WE 0740

0830

1 cig

0800

OTC

915

SS  baby and 1 child

SE 1230

1300-1359

1400-1459

1500-1559

1600-1659

1700-1759

1800-1859

1900-1959

2000-2059

2100-2159

2200-2259

2300-2359

2400-2459

L 1330

1 cig

16 oz

coffee

Coke 12 oz

XS 1620----

XE1650

1830 AL 1 unit

Cig 2

1900D*

H20

NS 2040-

NE 2120

HT 2130–2200

WS

2300

2420: chips, 16 oz diet coke

Instructions: Mark your daily work and personal activities using the following  symbols:

Activity

Start

End symbols

Hours of sleep

SS   -- Go to bed/sleep

SE  -- Sleep ends – awake

Napping:

NS  -- Nap starts

NE – Nap ends – awake

Hours and time of work

WS –  Start work

WE – Finish work

Time of exercise 

XS  -- Begin exercise period

XE --  End exercise period

Over-the-counter sleep meds -  Document OTC at time taken   

Sleeping arrangement: list number of others (husband, significant other, child or children sharing sleeping area or bed. 

ANIMALS: remove all animals from the sleeping area.  Animals can disturb sleep and excess movement can interfere with sleep data

Personal Illness: Mark start and end of illness during five days  (lls and illE)   

Time of meal intake record type/time;  put an asterisk ** next to your largest meal for the day

M – Breakfast or morning meal

L  -  Lunch or midday meal

D –  Evening meal (dinner or supper)

H20-   Record each 8 ounces of  water intake  example H20-2  means 2  (8 ounce) glasses of water intake 

Record Other Activities:

Intake other than Meals: Mark snacks or other intake (type and amount)

                        Example:   2220: French fries (small), 16 oz diet coke.  0320: 8 oz coffee

Alcohol  (AL) Intake:  record as units (1 unit = 8 oz beer or 4 oz wine or 1 oz alcohol)

                        Example: 1830 AL 1 unit 

Tobacco use: record time and number of cigarette (cig) or chew (chw)  Example: 0915  2-cig

Record sweat lodge (SL) or hot-tub (HT) use

                        Example: HT 2130---2200

Write down any extraneous noises that disturb your  sleep such as construction noise, door bells, sirens, baby crying,  etc.

To ensure a complete set of data, you must continually wear the Actiwatch for 5 days (60 hours).  You may bath and/or shower with the equipment on.  If you have questions, please call Barbara Hobbs (605)718-6063