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  • Sleep Diary: Answer in The Morning After Waking For The Day

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    zrombie7
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    This document is a 7-day sleep diary that collects information about a person's sleep patterns and habits. Each day asks the person to record the time they went to bed, how long it took to fall asleep, how many times they awoke during the night, their total sleep hours, and how they felt upon waking. It also asks about daytime napping, substance use near bedtime, and a self-rating of daily functioning. The diary collects both subjective and objective data about sleep over a one-week period.

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    This document is a 7-day sleep diary that collects information about a person's sleep patterns and habits. Each day asks the person to record the time they went to bed, how long it took to fall asleep, how many times they awoke during the night, their total sleep hours, and how they felt upon waking. It also asks about daytime napping, substance use near bedtime, and a self-rating of daily functioning. The diary collects both subjective and objective data about sleep over a one-week period.

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    © All Rights Reserved
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    17 views2 pages

    Sleep Diary: Answer in The Morning After Waking For The Day

    Uploaded by

    zrombie7
    This document is a 7-day sleep diary that collects information about a person's sleep patterns and habits. Each day asks the person to record the time they went to bed, how long it took to fall asleep, how many times they awoke during the night, their total sleep hours, and how they felt upon waking. It also asks about daytime napping, substance use near bedtime, and a self-rating of daily functioning. The diary collects both subjective and objective data about sleep over a one-week period.

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    © All Rights Reserved
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    of 2

    SLEEP DIARY

    ANSWER IN THE MORNING AFTER WAKING FOR THE DAY

    Approximately About how many Overall, about At what time did


    At what time did
    how long did times, if any, did how many you wake up In general, how did you feel
    you first go to bed
    it take you to you awaken hours did you (for the last time) when you woke up?
    last night?
    fall asleep? during the night? sleep? this morning?

    Very refreshed

    DAY 1 Somewhat refreshed

    Fatigued

    Very refreshed
    DAY 2 Somewhat refreshed

    Fatigued

    Very refreshed

    DAY 3 Somewhat refreshed

    Fatigued

    Very refreshed

    DAY 4 Somewhat refreshed

    Fatigued

    Very refreshed

    DAY 5 Somewhat refreshed

    Fatigued

    Very refreshed
    DAY 6
    Somewhat refreshed

    Fatigued

    Very refreshed
    DAY 7 Somewhat refreshed

    Fatigued

    --- page 1 ---


    SLEEP DIARY

    ANSWER AT BEDTIME JUST BEFORE YOU GO TO SLEEP

    How much time, if any, On a scale of one to five, how would


    Did you consume any of these substances
    did you spend napping you rate your overall functioning
    during the day?
    during the day? during the day?

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 1 Alcohol (within 1 hour of bedtime) 3
    Medication (type:_______________) 2
    1 - Lethargic

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 2 Alcohol (within 1 hour of bedtime) 3
    Medication (type:_______________) 2
    1 - Lethargic

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 3 Alcohol (within 1 hour of bedtime) 3

    Medication (type:_______________) 2
    1 - Lethargic

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 4 Alcohol (within 1 hour of bedtime) 3

    Medication (type:_______________) 2
    1 - Lethargic

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 5 Alcohol (within 1 hour of bedtime) 3

    Medication (type:_______________) 2
    1 - Lethargic

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 6
    Alcohol (within 1 hour of bedtime) 3

    Medication (type:_______________) 2
    1 - Lethargic

    5 - Energetic
    Caffeine (within 6 hours of bedtime) 4
    DAY 7 Alcohol (within 1 hour of bedtime) 3
    Medication (type:_______________) 2
    1 - Lethargic

    --- page 2 ---

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