Sleep Diary

Mon, Jul 13, 2009

Ask the DoctorSleep Dairy


1 Write the date, day of the week, and type of day: Work, School, Day Off, or Vacation
2 Put the letter “C” in the box when you have coffee, cola or tea          
3 Put “M” when you take any medicine    
4 Put a line (l) to show when you go to bed                     
5 Shade the box that shows when you think you fell asleep            
6 Leave boxes unshaded to show when you wake up at night             
    and when you are awake during the day.            
7 On a Monday when I worked, I jogged on my lunch break at 1 PM        
    had a glass of wine with dinner at 6 PM            
    fell asleep watching TV from 7 to 8 PM            
    went to bed at 11PM                      
    fell asleep around Midnight                  
    woke up and couldn’t get back to sleep at about 4 AM      
    went back to sleep from 5 to 7 AM              
    had coffee and medicine at 7:00 in the morning        
      Week 1   Week 2
      Mon Tue Wed Thu Fri Sat Sun   Mon Tue Wed Thu Fri Sat Sun
  Today’s Date                                
  Day of the week                                
  Type of Day                                
  1 PM                                
  2 PM                                
  3 PM                                
  4 PM                                
  5 PM                                
  6 PM                                
  7 PM                                
  8 PM                                
  9 PM                                
  10 PM                                
  11 PM                                
  1 AM                                
  2 AM                                
  3 AM                                
  4 AM                                
  5 AM                                
  6 AM                                
  7 AM                                
  8 AM                                
  9 AM                                
  10 AM                                
  11 AM                                
, , , , , ,

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