Sleep Sheet – Weekly

Download the printable PDF version…

Name: _______________________________________


Week # ___________ Mon Tue Wed Thu Fri Sat Sun
Fill in Date:               
What sleep prep ritual, meds
or induction procedure did
you use?
What time did you go to bed?

“Lights out” time for sleep?



About how long did it take you to fall asleep (rounded to ¼ hour)? C              
How many times did you wake up during the night? D              
About how long were you awake during the night (total time of awakenings rounded to ¼ hour)?  E              
Final wake up time?
When did you get out of bed?


What was your total
Time in Bed?
[B until G]
What was your
Total Sleep Time?
[B until G – (C + E)]
How refreshing was your sleep?

Poor    Fair    Good    Excellent
1   2   3   4   5   6   7   8   9   10

Sleep Efficiency (SE)

SE = I (TST) x 100 =
        H (TIB)

  _____% _____% _____% _____% _____% _____% _____%

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