Fill out this sleep journal every morning for 1 to 2 weeks. It can help you see what gets in the way of a good night's sleep. It could also help your doctor know more about what affects your sleep.
Day |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
---|---|---|---|---|---|---|---|
What time did you go to bed last night? |
|||||||
How long did it take to fall asleep? |
|||||||
What time did you get up? |
|||||||
Did you wake up during your sleep time? How many times? For how long? Did you get out of bed? |
|||||||
How much total sleep did you get? |
|||||||
How tired do you feel, on a scale of 1 to 5? (Very tired = 5) |
|||||||
Overall, how tired did you feel yesterday, on a scale of 1 to 5? (Very tired = 5) |
|||||||
How unusual or stressful was your day yesterday, on a scale of 1 to 5? (Very unusual or stressful = 5) |
|||||||
What did you do during the 30 minutes before bed? |
|||||||
Yesterday, did you: Take any naps? How long? When? |
|||||||
Yesterday, did you: Drink alcohol? How much? |
|||||||
Yesterday, did you: Have any caffeine? How much? When? |
|||||||
Yesterday, did you: Do any physical activity? What? When? |
|||||||
Yesterday, did you: Eat big or spicy meals? What? When? |
|||||||
Yesterday, did you: Take any medicines, including over-the-counter or herbal ones? What? When? |
Current as of: February 9, 2022
Author: Healthwise Staff
Medical Review:Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & Lisa S. Weinstock MD - Psychiatry
This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.
To learn more about Healthwise, visit Healthwise.org.
© 1995-2022 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Follow Us
Disclaimer
Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., and Cigna HealthCare of North Carolina, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Group Universal Life (GUL) insurance plans are insured by CGLIC. Life (other than GUL), accident, critical illness, hospital indemnity, and disability plans are insured or administered by Life Insurance Company of North America, except in NY, where insured plans are offered by Cigna Life Insurance Company of New York (New York, NY). All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.
Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Cigna may not control the content or links of non-Cigna websites. Details