SLEEP DIARY

Name:

Questions 1 and 2 should be filled in before bed and the rest of the form – in the morning. Remember to mark the date.

Example / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday
1. How would you rate your overall performance today?
1 = very good, 2 =good, 3 = moderate, 4 = poor, 5 = very poor / 4
2. Did you take one or more naps during the day? Note down the time and duration. / 16-16.30 and 18.15-18.30
3. Have you taken any barbiturates or alcohol, to help you sleep? Note down the quantity. / 5 mg Zopiclone;
1 glass of red wine
4. When did you go to bed? When did you turn off the lights? / 22.30 23.00
5. After the lights were switched off, how long did it take you to fall asleep? / 45 min
6. How many times did you wake up during the night? / 3
7. How long did you awaken for? (Indicate number of minutes) / 15, 30, 80
8. In the morning, did you feel like you hadn't really slept through the night? Please note what time you woke up last. / 06.15
9. When did you wake up? / 06.40
10. How would you rate last night's sleep?
1 = very restless, 2= restless, 3 = moderate, 4 = deep, 5 = very deep. / 1

Identify Your Sleep Diary

How do you sleep?

Filling in a sleep diary, for a couple of weeks, is an effective and simple way to track your sleep pattern. Sleep diaries are often used for moderate sleep disorders, to help understand the issue better, as well as to provide a base-line for follow-up, once you have begun the treatment.

Sleep diary manual

Please fill in the first two questions before bed and the rest – in the morning, immediately after waking up. It’s important to fill in the sleep journal every single day.

It’s difficult to figure out how long it takes you to fall asleep, or the duration of your period of wakefulness, throughout the night. Yet you’ll notice that the journal contains such questions. What we would like you to do is to provide an estimate – do not look at the clock. If you experienced a disturbance, especially during the night, note it down (such as an illness, a phone call, loud noises, etc.).

Below you’ll find some helpful tips for filling in your sleep journal. An example is also provided in the journal.

  1. Quality of your day: Use the scale provided in the sleep journal to rate how you performed during the day.
  2. Napping: It’s important to note all sleep, which did not happen during the allocated nighttime. Even if you dozed off accidentally, it is still important to record it. For instance, if you fell asleep in front of the TV for 10 minutes, this information should go in your sleep journal.
  3. Sleep aid: Write down anything you took to help you sleep. These may be pills, including non-prescription, as well as alcohol.
  4. Bedtime: Two moments should be taken into account here – the time you actually go to bed, and the time you switch off the lights. For example, if you go to bed at 10:45 PM but turn off the lights at 11:15 PM, note down both.
  5. Falling asleep: Give your best estimate of how long you took to fall asleep, after you had turned off the light.
  6. Awakenings: Note down how many times you woke up during the night. Write down as many as you remember.
  7. Duration of awakenings: Enter an estimation of how long you were awake for, each time that you woke up. Even if it feels impossible to tell, try to enter the approximate amount of time that you spent awake, throughout the night. Do not include the span of time from when you woke up to when you go out of bed in the morning. It will come up in the next question.
  8. Morning alertness: If you woke up before you were supposed to, and couldn’t fall back asleep, note down that time. Let’s say that you woke up at. 04:00 AM and did not sleep after – write down 04:00 AM. If you, however, you woke up at 04:00 AM and then fell asleep again for a while (ex. from 06:00 to 6:20), then you should fill in in 06:20 AM.
  9. The time when you got up: Write down the time when you got out of bed.
  10. Quality of sleep: Use the scale in the sleep journal to specify your experience.