Sleep quality |
How was your sleep quality for last night? |
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Worst possible sleep |
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Best possible sleep |
Mood |
How was your mood for today? |
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Overall anxious, irritable, unhappy, restless, and easily annoyed, overwhelmed by my day |
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Overall calm, reasonably content, able to handle what the day threw at me. |
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I felt great today |
Fatigue |
How tired did you feel today? |
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I felt really tired, low energy, unable to do my daily tasks |
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Fair level of energy, able to do daily tasks with minimal difficulty |
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I had lots of energy today |
Daytime wakefulness |
Did you fall asleep during the day today? |
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I fell asleep even though I didn't want to. I may not have been in my bed, but couldn't keep my eyes open |
I felt sleepy and fell asleep even though I didn't do anything too tiring |
I felt sleepy and had to lie down and rest during the day after activities |
I had a nap today because I could, but could have managed without |
I felt sleepy but was able to stay awake |
I did not feel sleepy other than usual dips after lunch and late afternoon Was able to stay awake all day |
I was completely alert throughout the day |
Attention |
Rate your attentiveness and concentration for today? |
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I couldn't concentrate today (following a conversation, reading watching television, couldn't block out things that distracted me, (e.g. pain, thoughts, ringing in the ears, background noises, conversations) |
Really hard to pay attention. I kept focused on 1 thing briefly but got distracted |
Hard to pay attention but I can follow tasks and get back on track if distracted. May need help to get refocused Can only do one thing at a time |
Some difficulty paying attention and following task(s). I occasionally have to get back on track if distracted, or do one thing at a time |
Fairly easy to block out distractions, I can pay attention for moderate periods of time (e.g. long enough to complete my daily tasks) |
Able to pay attention to more than one thing at a time for a period of time, or to focus for a period of time |
No difficulties paying attention today even for long periods of time or for multi‐tasking |
Memory |
Rate your memory abilities for today? |
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Can't remember activities, events, or conversations from today |
If reminded, can remember the gist of some activities, events, or conversations from today |
If reminded, can remember details of activities, events or conversation |
With no reminders can remember the gist of some activities, events or conversations from today |
Can remember several details of activities, events or conversations from today |
Can remember almost all the details of activities events or conversations from today |
My memory was just fine today |
Language processing |
Rate your communication and conversation abilities for today? |
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Was unable to carry on a conversation today. My conversation partner must always speak slower and simplify the topic |
Can carry on a conversation with one person, but need extra time to think and respond. At times conversation partner must speak slower and simplify the topic |
Can carry on a conversation. Helps when conversation partner speaks slower. Can carry on multispeaker conversations briefly if topic stays the same, but I need extra time to think and respond |
Can carry on a conversation. Partner doesn't need to speak slower. Some difficulty following and responding to multi‐speaker conversations, but I can do it |
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Can keep up with and reply to a multi person or single person conversation with minimal difficulty |
No difficulties following any conversations, meetings, phone‐calls even with multiple speakers |