Sleep Diary Template
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1Sleep Diary
Complete this form each day: write in the shaded area just before going to bed, and the non-shaded area in the morning
Day / date
Mood level during the
day
0 – 10 (10 worst)
Fatigue level during the
day
0 – 10 (10 worst)
Naps taken during day
– what time?
How long for?
Activity during day?
0 – 10 (10 most active)
Caffeine, nicotine,
alcohol during day, and
during evening?
What did I do just
before going to bed?
What time I went to
bed
What did I do in bed?
(Read, TV, sex)
What time did I put the
lights out?
How many minutes
before I fell asleep?
What time did I wake
up?
Number of times I woke
up?
Number of hours I
slept?
On waking up in the
morning, how rested do
I feel?
0 – 10 (10 most rested)
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Parent category: Life