Create a sleep log
Print out and fill in the sleep log each day for one to two weeks. Keep your answers brief, but be as specific as possible. If you have trouble identifying a cause or are concerned about your insomnia, bring these logs to your doctor.
Day/date: _______
Time you went to bed last night: ________ PM ______ AM
Time you started your day today: ________ AM _______ PM
Overall rating: On a scale of 1 to 10, how well did you sleep? _____
Quality of your sleep last night
How long did it take to fall asleep? ________
Total amount of time you slept: _______________
Describe the quality of your sleep last night. (Frequent waking? Deep sleep?)
____________________________________________
If you woke up during the night:
How often? _______________
About what time(s)? _______________
Describe what woke you each time (for example: worry, physical discomfort, snoring partner, sweating, need to go to bathroom). ___________________________________________
Were you able to fall back to sleep? _______________
If not, about how long did you remain awake? _______________
Were you snoring, kicking or tossing and turning during sleep? (Ask your bed partner if you can't recall.) ___________________________________________
Did you feel your breathing stop or a choking sensation? ___________
The day after
How well were you able to pursue your day's activities today? ______________________
Did you feel well rested when you started your day? ____
Briefly describe your energy level, sleepiness, fatigue, mood and ability to get your work done. Did you need to take a nap? Add time of day if possible.
______________________________________________________
Activities that may have affected your sleep last night
Did you have any difficulties or stress during the day? ____________
Did you eat close to bedtime? _________
At what time? ________
Was it a fairly heavy meal? ________________
Just a snack? _______________
Did you drink any beverages containing alcohol or caffeine?
At what time? ________
How many cups or glasses? _______
Did you take any medications or drugs that evening? __________
If yes, which ones? _____________
If yes, at what time? _____
Did you smoke? ________ At what time? ______ How many cigarettes? ______
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