Sleep Diary Day 1 1 Did you have a calm routine before you went to bed last night?

2 Did you have a nap during the day? 3 Did you take a sleeping tablet? 4 What time did you go to bed? !ow physically rela"ed were you in bed? # 1 2 3 4 &ery Day 2 Day 3 Day 4

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' !ow active was your mind? # 1 2 3 4 &ery

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( !ow well did you sleep? # )adly 1 2 3 4 Well

*airly well

+ ,f you slept badly what do you think was the cause? -.g. $oise/ an"iety/ discomfort/ restlessness 0 What strategy did you use to help you sleep? -.g. rela"ation/ ear plugs/ lavender/ herbal tea/ eye mask !ow helpful was it? # 1 2 3 4 &ery

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1# What time did you wake up? 11 What time did you get up? 12 !ow refreshed do you feel? # 1 2 3 4

12 Sleep Diary $ot at all %oderately &ery

Sleep Diary Day Day ' Day (

Sleep Diary