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TWO WEEK SLEEP DIARY INSTRUCTIONS: (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. Put “M” when you take any medicine. Put “A” when you drink alcohol. Put “E” when you exercise.
INSTRUCTIONS: TWO WEEK SLEEP DIARY 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. Put “M” when you take any medicine. Put “A” when you drink alcohol. Put “E” when you exercise. 3. Put a line (l) to show when you go to bed.
Stanford Sleep Health and Insomnia Program: Two Week Sleep Diary Adapted from the American Academy of Sleep Medicine. Write the date, day of the week, and type of day: Work, School, Day Off, or Vacation.
TWO WEEK SLEEP DIARY. INSTRUCTIONS: Write the date, day or the week and type of day: (W)ork, (S)chool, (O)ff or (V)acation. Put the letter “C” in the box when you have any caffeinated beverage or supplement that includes caffeine. Put “M” when you take ANY Medication. Put “A” when you drink alcohol. Put “E” when you exercise.
Write in how long it took you to fall asleep at night. Example: On June 22nd (Monday when I worked) I had an hour nap at 3:00 p.m., exercised at 5:00 & 9:00 p.m., took a medicine at 9:00 a.m., went to bed at 10:00 p.m. but did not fall asleep until 11:00 p.m. I had coffee at 9:00 a.m. and a soda at noon.
• Use your sleep diary every day for two weeks (or for as long as recommended by your healthcare professional). • Keep it near where you sleep, such as on a bedside table. Don’t forget a pen or pencil. • Complete the diary when you wake up for the day AND before you go to bed.
TWO WEEK SLEEP DIARY. INSTRUCTIONS: (1) Write the date, day of the week, and type of day: Work, School, Day Off, or Vacation. Put “M” when you take any medicine. Put “A” when you drink alcohol. Put “E” when you exercise. (2) Put the letter “C” in the box when you have coffee, cola or tea.
