Print this page, complete it, and review it with your doctor.

How did you feel today?
Did you nap?          
How long?          
Time into bed?          
Time "lights out?"          
Time to fall asleep?          
Number of awakenings?          
Duration of longest awakening?          
When was this awakening?          
Time of "lights on"?          
Time out of bed?          
Estimate of total sleep time?          
How refreshed did you feel when you woke up? (with 1 being not refreshed and 5 being very refreshed)          
List what you drank and ate during the 4 hours before bedtime