Sleep Diary Log
Keeping a sleep diary can help you and your healthcare provider better understand your sleep patterns.
Fill this out each morning based on the previous night. Consult with your healthcare provider regarding your sleep symptoms and patterns.
Daily Sleep Record
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Date |
Time You Went to Bed |
Time You Tried to Sleep |
Time You Fell Asleep |
Number of Times You Woke Up |
Total Time Awake During the Night |
Time You Woke Up for the Day |
Time You Got Out of Bed |
Total Sleep Time (estimate) |
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Click here for a printer-friendly Sleep Diary/Log
Sleep Quality
Circle one:
Poor / Fair / Good / Very Good / Excellent
Daytime Habits
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Naps? (Y/N) |
Nap Length |
Caffeine Today? (Y/N) |
Exercise Today? (Y/N) |
Alcohol Today? (Y/N) |
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Evening Factors
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Screen Time Before Bed? |
Late Meal? |
Stress or Worry? |
Pain or Discomfort? |
Medications or Sleep Aids
Did you take anything to help with sleep?
☐ Yes
☐ No
If yes, what did you take?
Morning Feelings
How did you feel when you woke up?
☐ Rested
☐ Somewhat tired
☐ Very tired
☐ Alert
Notes
Anything unusual about your sleep?
Examples:
- Noise
- Bathroom trips
- Temperature
- Dreams
- Illness
Weekly Summary
At the end of the week, reflect:
Did you notice:
☐ Trouble falling asleep
☐ Frequent awakenings
☐ Early waking
☐ Daytime fatigue
⚠️ Medical Disclaimer
This resource is provided for educational and informational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. The information presented is general in nature and may not apply to every individual or health situation.
Individuals should consult their physician or other qualified healthcare professional for personalized medical advice, diagnosis, or treatment recommendations related to their specific health conditions and should not begin any new exercise program or change their diet or medications without consulting their healthcare professional.
Call 911 if you are experiencing a medical emergency.