Hazzard's Geriatric Medicine and Gerontology, 8e >Sleep Disorders

Jeffrey B. Halter, Joseph G. Ouslander, Stephanie Studenski, Kevin P. High, Sanjay Asthana, Mark A. Supiano, Christine S. Ritchie, Kenneth Schmader+
TABLE 44-4SAMPLE SLEEP DIARY

NAME:
____________________ DATE: _________________ TO __________________
_________

MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

1. Bedtime

2. Time taken to fall

asleep (after lights off)

3. Number of
nighttime awakenings

4. Wake-up time

5. Time out of bed

(morning)

6. Total sleep time

(night only)

7. Total wake time

(night only)

8. Nap time (if any)

9. Medication
(time/dosage)

10. Alcohol
(time/dosage)

11. How was your

sleep last night?a

12. How tired were

you in the morning?b

a1 = excellent to 5 = very poor; b1 = not tired to 5 = very tired.

Date of download: 12/29/22 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.