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Mental Health
Sleep diary
Print this page, complete it, and review it with your doctor.
| DATE: | |||||
| How did you feel today? |
|||||
| Did you nap? | |||||
| When? | |||||
| How long? | |||||
| Time into bed? | |||||
| Time "lights out?" | |||||
| Time to fall asleep? | |||||
| Number of awakenings? | |||||
| Duration of longest awakening? | |||||
| When was this awakening? | |||||
| Time of "lights on"? | |||||
| Time out of bed? | |||||
| Estimate of total sleep time? | |||||
| How refreshed did you feel when you woke up? (with 1 being not refreshed and 5 being very refreshed) | |||||
| List what you drank and ate during the 4 hours before bedtime |
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