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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. 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.
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.
• 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.
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.
SleepAbility Two‐Week Sleep Diary for _____ Page 2 Day/Date Time woke/woken Time got up What did he/she do in between waking and getting up? Time and length of all daytime naps.
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.
