Sleep Diary
Instructions:
In order to better understand your sleep and to assist in your diagnosis, the professionals at the Our Lady of Bellefonte Hospital Sleep Lab need to collect essential information about your sleep patterns. Please read the instructions below carefully before completing the OLBH Sleep Lab Sleep Diary. The diary should contain information about your sleeping patterns for a consecutive two-week period.
- Indicates the time that you actually turn off the lights and decide to try to sleep.
- Please list, in your estimate, the number of minutes it took to fall asleep after the lights were turned out.
- Indicates the final awakening of the morning. For example, if you awoke at 5:40, but went back to sleep until 6:00 - the information in the blank should be 6:00.
- Indicates the time you get out of bed to begin your day.
- Estimate the number of hours you actually slept vs. the number of hours you spent in bed.
- Indicates the number of times you recall waking up at night.
- Total minutes awakenings lasted. (ie. if you listed 3 awakenings with the first being 2 minutes, the second being 5 minutes, and the third being 15 minutes, your answer should be 22.)
- Provide medication names and the dosage of each, or the type of alcohol and the number of ounces consumed. Please indicate if medications are prescription or over-the-counter.
- Indicates the amount of time spent napping. This also should include unintentional naps, for example, dozing off in front of the TV for a few minutes.
- Rate your feeling of tiredness when you awoke. 1= Exhausted, 2= Tired, 3= Average, 4= Rather Refreshed, 5= Very Refreshed.
- Rate the overall quality of your sleep. 1= Very Disrupted, 2= Restless, 3 = Average Quality, 4= Sound, 5= Very Sound.
If you have any unusual occurrences, such as illnesses or an emergency, that disrupt your normal sleep patterns, please make a note on the bottom of your diary.
How the sample diary should look: Click
Here (Microsoft Word)
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