Sleep Diary

Sleep diary chart

If your child has a sleep problem, please collect the following information for three nights before you make an initial or follow-up appointment. This information will be very useful for designing an appropriate treatment plan.

Morning Awakening (Time):

Nap 1

1. Asleep at (time):
2. What you did:

3. How long your child slept (minutes):

   Nap 2

4. Asleep at (time):
5. What you did:

6. How long your child slept (minutes):

Evening Bedtime

1. Asleep at (time):
2. How long it took to go to sleep (minutes):
3. What you did:

Night Awakening 1

1. Awake at (time):
2. How long your child was awake (minutes):
3. What you did:

Night Awakening 2

1. Awake at (time):
2. How long your child was awake (minutes):
3. What you did: