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Most doctors will want you to keep a sleep diary for at least two weeks before diagnosing you with a circadian sleep disorder, or referring you to a specialist. You can print this one out to help you in this. Just use the Print function in your web browser (usually found under the File menu).
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Sleep Diary Dates: _____ - _____ |
Mon | Tues | Wed | Thu | Fri | Sat | Sun |
| What time did you first go to bed yesterday? | |||||||
| What time did you get to sleep? | |||||||
| About how many times, if any, did you awaken during the night? | |||||||
| On a scale of 1 (poor sleep, trouble sleeping at all) to 5 (slept like a baby), how would you rate the quality of your sleep this time? | |||||||
| Overall, about how many hours did you sleep? | |||||||
| At what time did you wake up (for the last time) today? | |||||||
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In general, how did you feel when you woke up? (refreshed? tired?) |
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| How much time, if any, did you spend napping during the day? | |||||||
Did you consume any of these substances during the day?
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| On a scale of 1 (depressed, lethargic) to 5 (positive,energetic), how would you rate your mood and overall functioning during the day? | |||||||
| What sort of exercise did you do today, and when? | |||||||
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Additional comments you think would be relevant: |
