Sample Sleep Log
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1SLEEP LOG: Please fill this out for the previous day and night no more than 3 hours after waking. The information can be an estimate when
necessary. This sleep log is provided by the National Sleep Foundation,
NAME _______________________________________
WEEK OF ___________________________________
DAY
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
1. Did you nap?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
a. For how long?
_____min
_____min
_____min
_____min
_____min
_____min
_____min
b. At what time?
_________
_________
_________
_________
_________
_________
_________
2. Did you have any caffeine* after 6pm?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
3. Did you drink alcohol after 6pm?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
4. Did you use nicotine after 6pm?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
5. Did you exercise?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
6. Did you eat a heavy meal or snack
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
after 6pm?
7. Did you take any sleeping medication
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
a. What medication?
_________
_________
_________
_________
_________
_________
_________
b. Amount
_________
_________
_________
_________
_________
_________
_________
c. At what time?
_________
_________
_________
_________
_________
_________
_________
8. Were you sleepy during the day?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
NIGHT
1. What time did you turn off the lights
to go to sleep?
2. What time did you wake up?
3. How many total hours did you sleep?
4. How many times did you wake up in the night?
5. Rate the quality of your sleep:
1=poor, 5=excellent
6. Do you feel you got enough sleep?
Caffeine = coffee, tea, caffeinated soda, chocolate, energy drinks, certain medications.
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