TWO-WEEK SLEEP DIARY: Please complete this sleep diary on the days preceding your appointment 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your name and date of birth in the designated fields at the top of the diary.
  3. For each day, write down the day of the week and date in the provided spaces.
  4. Use a down arrow (↓) to indicate the time you went to bed and an up arrow (↑) for when you woke up.
  5. Mark 'W' if you were awakened by an alarm or another person, and 'S' if you woke up on your own.
  6. Shade in periods during which you were asleep, including naps, and leave unshaded periods for awake times.

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Breus broke down what they are and when to quit them with these simple guidelines that make up the 3-2-1 rule for sleep: Three hours before you go to sleep, stop drinking alcohol. Two hours before you go to sleep, stop eating food. One hour before you go to sleep, stop drinking fluids.
It is often really helpful to make a sleep diary. It would be recommended that you keep this for two weeks. This will help you identify any patterns around the bedtime routine and sleep and have a log of where the problem areas are.
Before you go to bed and when you wake up, answer these questions: What time did you get into bed? How long did it take you to fall asleep? How many times did you wake up? How long did you stay awake each time? What time did you wake up for good? How well do you think you slept?
A sleep diary is a record of an individuals sleeping and waking times with related information, usually over a period of several weeks. It is self-reported or can be recorded by a caregiver. Example layout of a sleep diary. The sleep diary, or sleep log, is a tool used by doctors and patients.
During treatment, diaries guide treatment implementation and track its impact. Sleep diaries are of such importance in insomnia treatment that consensus guidelines recommend their routine use in insomnia research assessment (Buysse et al., 2006).

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The instructions stipulated that items about daytime activity such as caffeine, alcohol, and medication use or napping which appear on one side of the diary are to be completed at night before going to bed, while the remaining items which appear on the other side and query about the previous nights sleep are to be
Keep it near where you sleep, such as on a bedside table. Dont forget a pen or pencil. Complete the diary when you wake up for the day AND before you go to bed. Fill in as much information as you can to get the best picture of your sleep patterns.
10 hours before bed: No more caffeine. 3 hours before bed: No more food or alcohol. 2 hours before bed: No more work. 1 hour before bed: No more screen time (shut off all phones, TVs and computers).

two week sleep diary form