National Sleep Foundation Sleep Diary Template
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1
2National Sleep Foundation Sleep Diary
C O M P L E T E I N M O R N I N G
C O M P L E T E A T E N D O F D A Y
I went to
I got out of
I woke up
When I woke
Last night
My sleep was
I consumed
I exercised
Approximatel
Medication(s)
About 1 hour
Last night,
bed last
bed this
during the
up for the
I slept a
caffeinated
at least 20
y 2-3 hours
I took during
before going
Fill out days
I fell
disturbed by:
night at:
morning at:
night:
day, I felt:
total of:
drinks in the:
minutes
before going
the day:
to sleep, I did
asleep in:
1-4 below and
(List any mental,
in the:
to bed, I
the following
days 5-7
emotional, physical
(Record number
(e.g. coffee, tea,
[List name of
(Record number
(Check one)
consumed:
activity:
or environmental
of hours)
cola)
medication/drug(s)]
on page 2
of times)
factors that affected
(List activity; e.g.
your sleep; e.g.
stress, snoring,
watch TV, work,
physical discomfort,
read)
temperature)
Morning
Morning
____________
____________
____________
DAY 1
Afternoon
Refreshed
Alcohol
Afternoon
____________
____________
____________
Within several
Within several
A heavy
DAY________
Somewhat
hours before
meal
____PM/AM
____PM/AM
___Minutes
____Times
____Hours
____________
hours before
____________
____________
refreshed
going to bed
going to bed
Not
____________
____________
____________
DATE_______
Fatigued
Not
applicable
Not
____________
____________
____________
applicable
applicable
Morning
Morning
____________
____________
____________
DAY 2
Refreshed
Afternoon
Alcohol
Afternoon
____________
____________
____________
Within several
A heavy
Within several
DAY________
Somewhat
hours before
____PM/AM
____PM/AM
___Minutes
____Times
____Hours
meal
____________
hours before
____________
____________
refreshed
going to bed
Not
going to bed
DATE_______
____________
____________
____________
Fatigued
Not
applicable
Not
____________
____________
____________
applicable
applicable
Morning
Morning
____________
____________
____________
DAY 3
Refreshed
Afternoon
Alcohol
Afternoon
____________
____________
____________
Within several
A heavy
Within several
DAY________
Somewhat
hours before
meal
____PM/AM
____PM/AM
___Minutes
____Times
____Hours
____________
hours before
____________
____________
refreshed
going to bed
going to bed
Not
____________
____________
____________
DATE_______
Fatigued
Not
applicable
Not
____________
____________
____________
applicable
applicable
Morning
Morning
____________
____________
____________
DAY 4
Afternoon
Refreshed
Afternoon
Alcohol
____________
Within several
____________
____________
A heavy
Within several
DAY________
Somewhat
hours before
____PM/AM
____PM/AM
___Minutes
____Times
____Hours
____________
hours before
meal
____________
____________
refreshed
going to bed
going to bed
Not
DATE_______
____________
____________
____________
Not
Fatigued
Not
applicable
____________
____________
____________
applicable
applicable
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