Sleep Log Template printable pdf download

Sleep Log

Sleep logs can be helpful for diagnoses of sleep disorders. They are the most efficient way for you and your doctor to evaluate your sleep

difficulties. Any patient of a sleep disorder clinic is required to keep a sleep log. More than likely, your doctor will ask you to complete a sleep log

for a period of several weeks; already completing this log may expedite your diagnosis and treatment. Most sleep specialists recommend

maintaining a sleep log for 2-4 consecutive weeks. Bring this sleep log to your doctor or sleep specialist at the time of your appointment.

Please fill out this Sleep Log for the previous day and night no more than 3 hours after waking up. Estimate approximate times for each of the

questions. Detailed accuracy is not essential.

This sleep log provided by Talk About Sleep,

Name: __________________________________________

Week of: ________________________________________

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Date:

DAY

1) Did you take a nap?

Yeso Noo

a) For how long?

______mins.

b) At what time?

__________

2) Did you have any caffeine* after 6 p.m.?

Yeso Noo

3) Did you have any alcohol after 6 p.m.?

Yeso Noo

4) Did you use nicotine after 6 p.m.?

Yeso Noo

5) Did you exercise?

Yeso Noo

6) Did you eat a heavy meal or snack after

Yeso Noo

6 p.m.?

7) Did you take any sleeping medication?

Yeso Noo

a) What medication?

__________

b) Amount?

__________

c) At what time?

__________

8) Were you sleepy during the day?

Yeso Noo

NIGHT

1) At what time did you turn off your lights

to go to sleep?

2) At what time did you wake up?

3) How many total hours did you sleep?

4) How many times did you wake up or get

up during the night?

5) Rate the quality of your sleep:

1 = poor 5 = excellent

6) Do you feel that you got an adequate

Yeso Noo

amount of sleep?

*Caffeine = coffee, tea, caffeinated soda, chocolate, certain medications

Sleep Log Template

Related Articles

Related forms

Related Categories