INFORMATION ABOUT THE ADULT NAP STUDY:

We are studying the ability of light to reset the body clock. The results of this study could be used to develop ways for people who need to reset their body clock; for example, to adjust to night work or after flying across many time zones.

The study takes 4 weeks in total and it always starts on a Friday (considered Day 0 of the study). It includes two 5-day lab sessions in the 2nd and 4th weeks of the study; these will start on a Sunday afternoon and end on the following Friday afternoon. You will spend a total of 10 days and 10 nights in our lab. During the rest of the study you will sleep at home, but must sleep according to a strict schedule that we will assign to you. This schedule will be similar to your typical sleep schedule, but you must go to bed and wake up at the same exact time every day. If you successfully complete the study, you will receive $1500. There will be two other subjects participating in the study at the same time as you.

Throughout the study, you will need to wear two pieces of equipment – one is a wrist monitor worn like a watch, and one is a light monitor worn like a necklace. On the first day of the study you will need to come to the lab for about 2 hours to collect the equipment and go through the procedures and rules of the study with one of our staff. For the first week of the study, you will sleep at home on a set schedule. Every 2 or 3 days you will have to visit the lab to have your wrist activity monitor downloaded to our computer so that we can make sure that you are following the sleep schedule and adhering to the study rules. These visits will take about 30-45 minutes.

On Sunday afternoon in the 2nd week of the study (Day 9), you will come to the lab for the first 5-day lab session. You will be in the lab for the entire time until the session ends on Friday afternoon; you will be at the lab continuously for 5 days and 5 nights. On the first and last days of each lab session there will be a “Lazy Boy session”. We will ask you to stay awake later than usual in dim light, reclined in a Lazy Boy chair. You will stay awake until about 4am during the first Lazy Boy session and until about 8am during the second Lazy Boy session. During this time we will collect saliva samples from you every half hour. You can watch TV or movies, play quiet games, or talk to other subjects. Saliva is collected by rolling a cylinder of cotton around in your mouth and placing it in a test tube. Food will be provided. On the other 3 days, you will nap. You will have the opportunity to sleep for more than 8 hours per day, but it is broken up into little naps across the day. You will sit in front of a bright light box for a few hours on 3 different occasions. The bright light is brighter than indoor lighting, but is much dimmer than sunlight on a bright, sunny day. We will show you how bright this light is if you come to the lab to learn more about the study.

At the end of the 5-day lab session, you will take a long nap before you go home. You are not allowed to drive yourself home after the 5-day laboratory session because you may be sleepy.

The 3rd and 4th weeks of the study will be very similar to the first 2 weeks of the study. You will sleep at home (days 15 – 22), and then you will participate in another 5-day lab session (days 23 – 28). This will conclude your study participation.

We have an extensive application process. If, after reading the information, you decide that you would like to pursue participation in the study, please complete all of the questions in the questionnaire and return it to us via email. Then we will let you know if you are eligible for the next step in the process of applying for the study. If you are not eligible for the study, we will not be able to disclose the reason(s) that you are not eligible. If, after reading the information about the study, you are no longer interested in applying, please email us and let us know that so we can remove you from our contact lists. Please feel free to contact us with any questions or concerns you have.

Upon receiving your completed questionnaire, we will review it and may call you to collect some additional information. After this follow-up phone call, we may then ask you to come in for an in-person meeting, during which we will explain the study in depth, show you the lab and equipment, measure your height and weight, give you a vision test, and ask you to fill in some questionnaires. If you drive to the lab for this appointment, we will be able to provide you with free parking in our adjacent garage. Only after that appointment, will we be able to tell you that you are eligible to participate in the study.

If you are still interested, please complete and return the following questionnaire via email (). If you would rather not complete these forms via email, we can ask you these questions over the phone. To do so, please call us at 312-563-4781. If you return the filled out questionnaire, you should hear from us within the next few days. Thank you for your interest!

For more information about our lab please visit our website: www.sleepclocklab.org


Adult Nap Study Email Questionnaire

Please answer the following questions as completely as possible. If any items are left unanswered, we will have to call you and this will delay the application process.

All of the information we receive is strictly confidential and will not be shared with anyone outside of our research staff. A number of factors help us to determine if you are a good fit for this particular study. Many volunteers will apply for this study, but unfortunately not everyone will be able to participate. If for some reason we are unable to include you in the study, you will receive an email letting you know.

Your First Name: Your Last Name:

What is your title?: Mr. Mrs. Ms. Dr. other, please specify:

What is your sex?: Female Male

What is your date of birth? What is your age? years

What is your height? What is your weight? pounds

Your Phone # (s): Home: Work: Cell:

When is the best time to call you? Home: Work: Cell:

Your Mailing Address:

Your Email address:

1. How did you hear about our study?

Facebook Postcard in mail

Kijiji Flyer (where? )

Backpage Newspaper ad (what newspaper? )

Craigslist Word of mouth

Chicago Reader online ad Our website (www.sleepclocklab.org)

Ebay Classified Other (please specify: )

2. Have you ever applied for or participated in any of our other studies? Yes No

If YES: Which one(s)? What was your code name(s)?

3. Are you currently participating in, or have you recently applied for, any research studies besides ours?

Yes No

If YES: Please provide some details:

4. Do you smoke? Yes (amount ) No

Have you recently quit smoking? Yes (when? No

5. Do you take any prescription medications? This includes any pills, creams, injections or anything you need a doctor’s prescription to get. Yes No

If YES: please list medications:

(Females only): Do you take birth control pills? Yes No

6. Do you wear glasses? Yes No Do you wear contacts? Yes No

7. Have you had or are you planning to have eye surgery (e.g. LASIK) Yes No

8. Are you color blind? Yes No I don’t know

9. The following is a list of medical conditions. Please check the box next to any you currently have or have ever had in the past.

retinal disease epilepsy or seizures bipolar disorder

cataracts GI disorder fetal alcohol syndrome

glaucoma depression sleep apnea

heart disease schizophrenia restless leg syndrome

kidney disease endocrine dysfunction

autoimmune disease liver disease other:

vascular disease migraine headaches

diabetes meningitis

eating disorder hepatitis

cancer lead poisoning

asthma allergies

10. Do you have a social security number? Yes No

11. Are you a student? Yes No If YES: Part time Full time

12. Do you have a job? Yes No

If YES: Part time Full time

If NO: Are you looking for a job? Yes No

13. Is your schedule flexible enough that you could spend 5 days and 5 nights in the lab (Sunday - Friday) in the 2nd and 4th week of the study? Yes No

14. In the next 2 – 3 months do you have any exams, weddings, vacations, trips or other special events scheduled?

15. What is your schedule like in a given week? Please list all appointments, job requirements, classes, meetings, etc. that have a fixed time to occur every week (you do not need to list what they are, just what blocks of time you would need for these activities).

Monday:

Tuesday:

Wednesday:

Thursday:

Friday:

Saturday:

Sunday:

16. How many other people live in your house with you?

Are they: Roommates Partner Family/Relatives

Any children? Yes No If YES, how old?

17. Do you have a bed partner or roommate that sleeps in the same room as you? Yes No

If yes, are they: Bed Partner Roommate in another bed, same room

18. Do you currently have any trouble sleeping, such as trouble falling asleep, staying asleep, waking up too early, waking up too late, not feeling rested the next day? Yes No

19. During the last month, at what time have you usually been turning the lights out to fall asleep…

on work/ weeknights? (remember to tell us if this is AM or PM).

on non-work/ weekend nights? (remember to tell us if this is AM or PM).

And, how long has it usually taken you to fall asleep after you turned the lights out…

on work/ weeknights? .

on non-work/ weekend nights? .

20. During the last month, at what time have you usually woken up in the morning…

on work/ weekdays? (remember to tell us if this is AM or PM).

on non-work/ weekend days? (remember to tell us if this is AM or PM).

Are you waking up because you have to (i.e. to get to class or work)? Yes No

21. On average, how much sleep do you get…

on work/ weeknights? hours

on non-work/ weekend nights? hours

22. During the last month, how often have you fallen asleep during the day before bedtime or taken naps?

23. How will you be getting to the lab for appointments? (We are located on Jackson Street

between Ashland and Paulina).

Car El Bus Other

If by car: We will provide free parking in the garage attached to our building if you are driving. Public transportation is also very easy to our building because we are near the Blue Line ‘Medical Center’ El stop, a short walk from the Pink Line ‘Polk’ El stop, as well as many bus lines. We cannot pay for public transportation.

After the 2 lab sessions you will be very tired. You cannot drive home after these sessions – you must either take public transportation or arrange for a ride home or call a cab. If you take a cab, we will reimburse your cab fare from the lab. What do you think you will probably end up doing?

Ride Public Transportation Cab Other

How long will it take you to get to the lab from your home?

24. This study will require you to stay awake much later than usual on 4 different occasions.

Do you think you will be able to do this? Yes No

Have you ever stayed up all night? Yes No

25. Have you ever worked night shifts? Yes No

If YES: When? What are/were your typical night shift hours?

26. Have you crossed any time zones recently? Yes No

If YES: Where did you go?

When did you return?

Are you planning to travel across time zones soon? Yes No

If YES: Where?

When will you return?

27. How often do you drink caffeine (e.g. coffee, tea, soda)?

What and how much do you have?

28. How many days/week do you drink alcohol?

What and how much do you have?

29. Would you be able to telephone the lab each morning as soon as you wake up, and at night right before you go to bed? (i.e., do you have a phone in your home?) Yes No

30. Do you have a cell phone or house phone in your bedroom? Yes No

If YES: would you be willing to turn it off/put it in another room/unplug it while you sleep?

Yes No

31. Is English your first language? Yes No

32. (Females only) Are you pregnant? Yes No

Are you trying to get pregnant? Yes No

When did your last period start?

And the month before that (if you can remember)?

Thank you for completing these questions!

PLEASE EMAIL COMPLETED FORM AS AN ATTACHMENT TO

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