Sleep Log Template printable pdf download

Sleep Log Template

Sleep Log

Name:

Example

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Week (beginning date to ending date):

Day 1

Fill out 1-6 prior to going to bed

1) I napped from _____ to ______ (note times of all naps

2:00 to 2:45 pm

2) I took _____ mg of sleep medication as a sleep aid

Prosom 1 mg

3) I took ____ oz of alcohol as a sleep aid

beer 12 oz

4) I went to bed at _____ o'clock

10:30

5) I turned the lights out at _____ o'clock

11:15

6) I plan to awaken at _____ o'clock

Fill out 7-13 the next day

7) After turning the lights out, I fell asleep in ___ minutes

8) My sleep was interrupted ____ times (specify numer of nighttime

awakenings)

9) My sleep was interrupted for ______ minutes (specify duration of each

awakening)

20, 30, 15

10) I woke up at _____ o'clock (note time of last awakening)

6:15

11) I got out of bed at _____ o'clock (specify the time)

6:40

12) When I got up this morning I felt_______.

(1=exhausted, 2=tired, 3=average, 4=rather refreshed, 5=very refreshed)

13) Overall, my sleep last night was _______.

(1=very restless, 2=restless, 3=average, 4==sound, 5=very sound)

Sleep Log Template