Sleep Diary

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If your child has a sleep problem, collect the following information for 3 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

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

3. 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:

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
Published by RelayHealth.
© 2009 RelayHealth and/or its affiliates. All Rights Reserved.