Sleep Diary Template - South Carolina Sleep Medicine
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1S
D
LEEP
IARY
92 Springview Lane
Summerville, SC 29485
Tel: 843-871-4006
Fax: 843-871-4074
Fill out Sleep Diary ONLY in the morning/daytime after waking up and out of bed. You should simply ESTIMATE time taken to fall asleep, # awakenings, etc. Add any additional
DO NOT look at the clock at night in order to complete this form
comments in the appropriate space on the back.
THIS MORNING
OVERALL MY SLEEP
AWAKENINGS
FINAL WAKETIME
TIME SPENT
DAY
DATE
BEDTIME
*SOL
I FELT:
LAST NIGHT WAS:
#
Duration
Awake
Out of Bed
ASLEEP
(good, better, worse)
(good, better, worse)
EXAMPLE
Monday
10-20-03
10:00 PM
20 mins.
3
2-5 mins.
6:00 AM
6:15 AM
7 hours
*SOL = Sleep Onset Latency (time taken to fall asleep)
Additional Comments:
SCSM F019- 08_2004
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Parent category: Life