Print this page, complete it, and review it with your doctor.
|How did you feel today?
|Did you nap?|
|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