Sleep Log: Example
Day of the week Sun Mon Tue Thu Thu Fri Sat
Bed time: Enter date & time
(mm/dd/yyyy 00:00 AM/PM)
11/1/09 8:30 PM 11/2/09 1:30 PM 11/3/09 10:30 AM 11/5/09 2:30 AM 11/5/09 8:30 PM 11/6/09 11:30 PM 11/7/09 11:30 PM
Wake time: Enter date & time
(mm/dd/yyyy 00:00 AM/PM)
11/2/09 8:30 AM 11/2/09 10:24 PM 11/3/09 6:44 PM 11/5/09 6:44 AM 11/6/09 7:44 AM 11/7/09 8:04 AM 11/8/09 4:44 AM
How many times did you
wake-up during your sleep period?
4 3 2 1 0 3 2
Did you take a sleep aid? Y/N
Y Y N N N N N
Did you take a nap? Y/N Y N N N N N N
A) For how long? (mins/hrs) 2 hrs
B) At what time? 3:00 PM
Did you have caffeine* within 4 hrs N N N N N Y Y
of bedtime? Y/N
Did you have any alcohol within 2 N N N Y N N N
hours of bedtime? Y/N
Did you use nicotine within N N N N N N N
2 hours of bedtime? Y/N
Did you exercise too close to N N N N N N N
bedtime (within 2-3 hrs)? Y/N
Did you eat a heavy meal or snack N N N Y N N N
within 2 hours of bedtime? Y/N
Were you sleepy during your awake N N N Y N N Y
time? Y/N
Do you feel you got an adequate N N Y N Y N N
amount of sleep? Y/N
Rate the quality of your sleep: 1 =
poor, 5 = excellent 3 3 3 2 4 3 2
Total Sleep time: (h:mm:ss). Will
auto calculate based on wake and
bed times
12:00:00 8:54:00 8:14:00 4:14:00 11:14:00 8:34:00 5:14:00
Your total average hours of sleep Note: Deduct 30 mins from your total for sleep inertia (the period it
this week takes to wake-up and fall asleep). If you are getting less than 7 hours of
(Naps not included): 8:20:34 sleep on average, you may need to change your sleep habits.
Note: If you are experiencing multiple awakenings (longer than 20 mins)
Your total average number of during your sleep period, you may have a sleep disorder and should
awakenings this week: 2.1 consult a physician.
This rating is based on a (1 - 5) scale. 1=poor, 5=excellent.
Quality of your sleep on average: 2.9
*Caffeine=coffee, tea, caffeinated soda, chocolate, energy drinks, & certain medications
Sleep Log: Week 1
Day of the week
Bed time: Enter date & time
(mm/dd/yyyy 00:00 AM/PM)
7/29/19 2:00 AM 7/30/19 1:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM
Wake time: Enter date & time
(mm/dd/yyyy 00:00 AM/PM)
7/29/19 11:00 AM 7/30/19 6:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM
How many times did you
wake-up during your sleep period?
0 0 0 0 0 0 0
Did you take a sleep aid? Y/N
Did you take a nap? Y/N
A) For how long? (mins/hrs)
B) At what time?
Did you have caffeine* within 4 hrs
of bedtime? Y/N
Did you have any alcohol within 2
hours of bedtime? Y/N
Did you use nicotine within 2 hours
of bedtime? Y/N
Did you exercise too close to
bedtime (within 2-3 hrs)? Y/N
Did you eat a heavy meal or snack
within 2 hours of bedtime? Y/N
Were you sleepy during your awake
time? Y/N
Do you feel you got an adequate
amount of sleep? Y/N
Rate the quality of your sleep: 1 =
poor, 5 = excellent 0 0 0 0 0 0 0
Total Sleep time: (h:mm:ss). Will
auto calculate based on wake and
bed times
0:00:00 5:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00
Your total average hours of sleep Note: Deduct 30 mins from your total for sleep inertia (the period it
this week takes to wake-up and fall asleep). If you are getting less than 7 hours of
(Naps not included): 0:42:51 sleep on average, you may need to change your sleep habits.
Note: If you are experiencing multiple awakenings (longer than 20 mins)
Your average number of awakenings during your sleep period, you may have a sleep disorder and should
this week: 0.0 consult a physician.
This rating is based on a (1 - 5) scale. 1=poor, 5=excellent.
Quality of your sleep on average: 0.0
*Caffeine=coffee, tea, caffeinated soda, chocolate, energy drinks, & certain medications
Sleep Log: Week 2
Day of the week
Bed time: Enter date & time
(mm/dd/yyyy 00:00 AM/PM)
12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM
Wake time: Enter date & time
(mm/dd/yyyy 00:00 AM/PM)
12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM 12/30/99 12:00 AM
How many times did you wake-up
during your sleep period?
0 0 0 0 0 0 0
Did you take a sleep aid? Y/N
Did you take a nap? Y/N
A) For how long? (mins/hrs)
B) At what time?
Did you have caffeine* within 4 hrs
of bedtime? Y/N
Did you have any alcohol within 2
hours of bedtime? Y/N
Did you use nicotine within 2 hours
of bedtime? Y/N
Did you exercise too close to
bedtime (within 2-3 hrs)? Y/N
Did you eat a heavy meal or snack
within 2 hours of bedtime? Y/N
Were you sleepy during your awake
time? Y/N
Do you feel you got an adequate
amount of sleep? Y/N
Rate the quality of your sleep: 1 =
poor, 5 = excellent 0 0 0 0 0 0 0
Total Sleep time: (h:mm:ss). Will
auto calculate based on wake and
bed times
0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00 0:00:00
Your total average hours of sleep Note: Deduct 30 mins from your total for sleep inertia (the period it
this week takes to wake-up and fall asleep). If you are getting less than 7 hours of
(Naps not included): 0:00:00 sleep on average, you may need to change your sleep habits.
Note: If you are experiencing multiple awakenings (longer than 20 mins)
Your average number of awakenings during your sleep period, you may have a sleep disorder and should
this week: 0.0 consult a physician.
This rating is based on a (1 - 5) scale. 1=poor, 5=excellent.
Quality of your sleep on average: 0.0
*Caffeine=coffee, tea, caffeinated soda, chocolate, energy drinks, & certain medications
