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Get American Academy of Sleep Medicine Two Week Sleep Diary

TWO WEEK SLEEP DIARY INSTRUCTIONS Write the date day of the week and type of day Work School Day Off or Vacation. 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. Put a line l to show when you go to bed. Shade in the box that shows when you think you fell asleep. Shade in all the boxes that show when you are asleep at night or when you take a nap during the day. Leave boxes unshaded to show when you wake up at night and when you are awake during the day. Work E A I 11AM 6AM Midnight 11PM 6PM Work School Off Vacation C M week 1 Mon. Type of Day week 2 sample Day of the Today s Date Noon SAMPLE ENTRY BELOW On a Monday when I worked I jogged on my lunch break at 1 PM had a glass of wine with dinner at 6 PM fell asleep watching TV from 7 to 8 PM went to bed at 10 30 PM fell asleep around Midnight woke up and couldn t got back to sleep at about 4 AM went back to sleep from 5 to 7 AM and had coffee and medicine at 7 00 in the morning. TWO WEEK SLEEP DIARY INSTRUCTIONS Write the date day of the week and type of day Work School Day Off or Vacation* 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. Put a line l to show when you go to bed* Shade in the box that shows when you think you fell asleep* Shade in all the boxes that show when you are asleep at night or when you take a nap during the day. Leave boxes unshaded to show when you wake up at night and when you are awake during the day. Work E A I 11AM 6AM Midnight 11PM 6PM Work School Off Vacation C M week 1 Mon* Type of Day week 2 sample Day of the Today s Date Noon SAMPLE ENTRY BELOW On a Monday when I worked I jogged on my lunch break at 1 PM had a glass of wine with dinner at 6 PM fell asleep watching TV from 7 to 8 PM went to bed at 10 30 PM fell asleep around Midnight woke up and couldn t got back to sleep at about 4 AM went back to sleep from 5 to 7 AM and had coffee and medicine at 7 00 in the morning. TWO WEEK SLEEP DIARY INSTRUCTIONS Write the date day of the week and type of day Work School Day Off or Vacation* 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. Put a line l to show when you go to bed* Shade in the box that shows when you think you fell asleep* Shade in all the boxes that show when you are asleep at night or when you take a nap during the day. Put A when you drink alcohol* Put E when you exercise. Put a line l to show when you go to bed* Shade in the box that shows when you think you fell asleep* Shade in all the boxes that show when you are asleep at night or when you take a nap during the day. Leave boxes unshaded to show when you wake up at night and when you are awake during the day. Work E A I 11AM 6AM Midnight 11PM 6PM Work School Off Vacation C M week 1 Mon* Type of Day week 2 sample Day of the Today s Date Noon SAMPLE ENTRY BELOW On a Monday when I worked I jogged on my lunch break at 1 PM had a glass of wine with dinner at 6 PM fell asleep watching TV from 7 to 8 PM went to bed at 10 30 PM fell asleep around Midnight woke up and couldn t got back to sleep at about 4 AM went back to sleep from 5 to 7 AM and had coffee and medicine at 7 00 in the morning. .

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