# National Sleep Foundation s Guide to Promoting, Marketing and Advocating Healthy Sleep in Your Community

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2 s Sleep Diary This is the week of COMPLETE IN THE EVENING BEFORE GOING TO BED In the space inside each figure, fill in the number of cans/glasses of caffeinated drinks, cups of coffee or tea, and/or chocolate you had each day. Day 1 Day 5 Day 2 Day 6 Day 3 Day 7 Day 4 Total for Week: Soda/energy drink cans or bottles Chocolate bars Coffee/Tea cups See NSF s Caffeine Calculator at to see how much caffeine you consume and how it may affect your sleep.

3 COMPLETE WHEN YOU WAKE UP What did you do in the HOUR before going to bed? ON THE WEB LISTEN TO MUSIC READ A BOOK EXERCISE/SPORTS WATCH TV ON THE PHONE/IM HOMEWORK VIDEO GAMES SNACK MOVIE HOBBY Day FAVORITE Book(s): Web site(s): Sport(s): TV program(s): Singer/group(s): Friends I talked to/stuff we talked about: Class(es): Game(s): Snack(s): Movie(s): Hobby(ies): How did you sleep? Place a Y yes or N no if you had any of these experiences during the night. Day Trouble falling asleep Frequent awakenings during the night Hard to wake up or feeling groggy Circle the number that best represents your sleep last night. I had a poor night s sleep I had a great night s sleep

4 On the clocks below, write in what time you went to sleep and what time you woke up. Then, fill in the total hours you slept. Calculate how much sleep, if any, you need to make up. What is your total sleep debt for the week? Day 1 Day 2 Hours you need Day 3 Day 4 Day 5 Hours you need Day 6 Day 7 Total/Week

5 Dreaming of: COMPLETE TODAY How I felt today: Keep track of your energy level and your ability to pay attention for each day. Note any pattern that occurs. In the space below, write in your rating of your night s sleep for each day. Compare hours of sleep and how well you slept to how you felt during the day. My energy level: No energy Low energy Medium energy High energy Very High energy I took # naps today for minutes at : am/pm. Daytime Performance How are you doing during wake time? Are you feeling great and energized or is sleep deprivation affecting your daytime activities? How easy or difficult was it for you to do each of these items today? Note any patterns related to your sleep habits. Activity Very difficult Somewhat difficult Somewhat easy Very easy Don t know Complete all of my assignments or do all of my school work Pay attention in class Solve math or word problems Read a text book Listen carefully Eat healthy Perform well on tests Be in a good mood Have a positive outlook Get along w/ family & friends Be on time to class & activities

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