Cognitive Behavioral Therapy for

Insomnia (CBTi)
Treatment Manual

Based on treatment methods developed by:

Richard R. Bootzin and Charles Morin

Based on a CBT Manual developed by:

Ricardo Munoz and Jeannine Miranda
Revisions by:
John McQuaid, Jocelyn Sze, and Poorni Otilingam

1
 Table of Contents

Topic Page

Session 1: Introduction 3
Session 2: Sleep Efficiency: Reclaiming the bed for sleep 9
Session 3: Sleep Hygiene Behaviors 13
Session 4: Sleep and Your Thoughts 16
Session 5+: Titration and Compliance 19
Session 6: Relapse Prevention: Action Plan for Addressing Insomnia in 20
the Future

2
Session 1

Purpose of today’s session:

1. Introduction and structure of treatment
2. Discuss Sleep log

INTRODUCTION

What this program is NOT:

 it’s not about “just drink some chamomile tea before bed”
 it’s not about fancy bells and whistles
 it’s not about sleep meds
 it’s not a magic pill

What this program is IS:

 it’s hard work
 it requires commitment
 it’s practical and focused
 it WORKS -- in fact, it’s the most effective treatment out there for insomnia!

Our GOALS:
 increase the amount of time you sleep
 increase the quality of your sleep
 increase control of your sleep patterns

How will we do this?

 Meet 5+ times
 Learn and practice specific strategies for improving sleep
 Track how the things we try are working
 Brainstorm to overcome hurdles

Why use CBTi for sleep problems?

 CBTi is considered the first-line, gold standard treatment for insomnia
o It works better than sleep meds in leading to durable improvement
o It has no side effects and no potential for dependency/addiction
o It’s a more affordable treatment option in the long run
 If you practice these behaviors every day, you should start to see improvement after only 4 weeks
 About 80% of people who complete CBTi demonstrate significant long-term sleep improvement

A note about sleeping medications:

 We are going to show you ways to manage your sleep without the use of sleep meds.
 On sleep meds, people often awaken feeling sedated or groggy.
 Often, sleep meds stop working over time because your body gets used to them.
 If you are currently taking sleep meds, you can still complete this treatment in conjunction with your
medication regimen. Always consult with your doctor first if you decide to make changes to your
medication regimen.

3
Exercise:
1. Complete the sleep log for last night as an example

Assignment:
1. Complete the sleep log each morning
2. Review Sleep Hygiene Guidelines and star the ones you think you might be breaking. Do not worry
if some of these guidelines don’t make immediate sense; we will be discussing certain guidelines in
more depth in future sessions.

4
 Sleep Hygiene Guidelines
Good dental hygiene is important in determining the health of your teeth and gums. Similarly, good sleep
hygiene is important in determining the quality and quantity of your sleep. Review the below guidelines
and check the ones you think you might be breaking.

Screen time: Turn off TV, computers, tablets, and smart phones 1 hour Before Bedtime
 The short waves of blue light (emitted from the screens of TVs, laptops, iPads, smart phones, etc.)
mimic daylight. Thinking it’s daytime, your brain suppresses melatonin and becomes more alert
because we have evolved to see this type of light only during the day. What’s more, the overall
stimulation we get from these devices serves to keep us more alert. If TV is your relaxing activity, try to
move it up a bit earlier in the evening.

Caffeine: Avoid Caffeine 6-8 Hours Before Bedtime

 Caffeine disturbs sleep, even in people who don’t think they experience a stimulation effect.
 Individuals with insomnia are often more sensitive to mild stimulants than are normal sleepers.
 Caffeine is found in items such as coffee, tea, soda, chocolate, and many over-the-counter medications
(e.g., Excedrin)
 Caffeine should be avoided in the afternoon and evening, preferably by 1pm. You might consider a trial
period of no caffeine at all.

Nicotine: Avoid Nicotine Before Bedtime

 Although some smokers claim that smoking helps them relax, nicotine is a stimulant.
 The initial relaxing effects occur with the initial entry of the nicotine, but as the nicotine builds in the
system it produces an effect similar to caffeine.
 Nicotine should be avoided near bedtime and during the night. Don’t smoke to get yourself back to
sleep.

Alcohol: Avoid Alcohol After Dinner

 Alcohol often promotes the onset of sleep, but as alcohol is metabolized sleep becomes disturbed and
fragmented, leading to poor sleep quality.
 Limit alcohol use to (1 beer or glass of wine for women, 2 for men).

Sleeping Pills: Sleep Medications are Effective Only Temporarily

 Research has shown that sleep meds lose their effectiveness in about 2 - 4 weeks when taken regularly.
 Over time, sleeping pills actually can make sleep problems worse. When sleeping pills have been used
for a long period, withdrawal from the medication can lead to an insomnia rebound. Thus, after long-
term use, many individuals incorrectly conclude that they “need” sleeping pills in order to sleep
normally.
 Keep use of sleep meds infrequent, but don’t worry if you need to use one on an occasional basis. (And
always consult with your doctor first if you decide to make changes to your medication regimen.)

Regular Exercise
 Exercise has been shown to aid sleep, although the positive effect often takes several weeks to become
noticeable.
 Exercise within 2 hours of bedtime may elevate nervous system activity and interfere with sleep onset.
 Get regular exercise, preferably at least 20 minutes each day of an activity that causes sweating.

5
Hot Baths
 Spending 20 minutes in a tub of hot water an hour or two prior to bedtime may promote sleep.

Bedroom Environment: Moderate Temperature, Quiet, and Dark

 Extremes of heat or cold can disrupt sleep.
 Noises can be masked with background white noise (such as the noise of a fan) or with earplugs.
 Bedrooms may be darkened with black-out shades or sleep masks can be worn.
 Position clocks out-of-sight since clock-watching can increase worry about the effects of lack of sleep.

Eating
 A light bedtime snack, such a glass of warm milk, cheese, or a bowl of cereal can promote sleep.
 Avoid heavy or spicy meals before bedtime and any caffeinated foods (e.g., chocolate).
 Avoid snacks in the middle of the night since awakening may become associated with hunger.
 Do not go to bed too hungry or too full.

Avoid/Reduce Naps
 The sleep you obtain during the day takes away from your sleep need that night resulting in lighter,
more restless sleep, difficulty falling asleep, and/or early morning awakening.
 Avoid naps. If you must nap, keep it brief. It is best to set an alarm to ensure you don’t sleep more than
15 minutes.

Limit Your Time in Bed

 Restrict your sleep period to the average number of hours you have actually slept per night during the
preceding week. Quality of sleep is important. Too much time in bed can decrease the quality on
subsequent night and contribute to the maintenance of existing sleep problems. Don’t lay in bed for
extended times not sleep. If you aren’t asleep in about 15-20 minutes go ahead and get up. Do
something outside the bedroom that is relaxing. When you feel sleepy (i.e., yawning, head bobbing,
eyes closing, concentration decreasing), then return to bed. Don’t confuse tiredness with sleepiness,
they are different. Tiredness doesn’t lead to sleep, only sleepiness does.
 Light exposure in the morning

Regular Sleep Schedule

 Keep a regular time each day, 7 days a week, to get out of bed. Keeping a regular awaking time helps
set your circadian rhythm set so that your body learns to sleep at the desired time.

6
 Sleep log Instructions
WHAT: A sleep log is designed to gather data about your daily sleep pattern.

HOW OFTEN and WHEN do I fill it out? It is important to complete your sleep log every day. Ideally, it
should be completed within one hour of getting out of bed in the morning.

What should I do if I miss a day? If you forget to fill in the log or are unable to finish it, leave the log blank
for that day.

What if something unusual affects my sleep or how I feel in the daytime? If your sleep or daytime
functioning is affected by some unusual event (such as an illness, or an emergency) you may make brief notes
on your log.

What do the words “bed” and “day” mean on the log? This log can be used for people who are awake or
asleep at unusual times. In the sleep log, the word “day” is the time when you choose or are required to be
awake. The term “bed” means the place where you usually sleep.

Will answering these questions about my sleep keep me awake? This is not usually a problem. You should
not worry about giving exact times, and you should not watch the clock. Just give your best estimate.

Item Instructions
Use the guide below to clarify what is being asked for each item of the Sleep log.
Date: Write the date of the morning you are filling out the log
1. What time did you get into bed? Record the time you got into bed for the night.
2. About what time did you fall asleep? This is difficult to pinpoint, so just give your best guess!
3. In total, about how long were you up in the middle of the night? Record the total time you were awake
between the time you first fell asleep and your final awakening. For example, if you woke 3 times for 10
minutes, 30 minutes, and 45 minutes, add them all up (10+30+45= 85 min or 1 hr and 25 min).
4. What time was your final awakening? Record the last time you woke up in the morning.
5. What time did you get out of bed for the day? Record the time you got out of bed.
6. Time in Bed. Calculate the total time you spent in bed (Item #5 minus #1)
7. Time Asleep. Calculate the total time you spent asleep (Item #4 minus #2, and also make sure to subtract #3 )
8. Sleep Efficiency. Divide Time Asleep by Time in Bed (Item #7 divided by #6)
9. How would you rate the quality of your sleep? “Sleep Quality” is your sense of whether your sleep was
good or poor.
10. In total, how long did you nap or doze yesterday? Record the total amount of time spent napping in the day.
11. Comments. Feel free to write anything that you would like to say that is relevant to your sleep.

At the end of the week, calculate the averages for #6, #7, and #8 using the Calculate Averages column.

7
 Sleep log
Sample
Today’s date Mon Calculated
1/1/12 Averages
1. What time did you
get into bed? 10:30 p.m.

2. About what time did

you fall asleep? 12 a.m.

3. In total, about how

long were you up in the 1 hour
middle of the night?
4. What time was your
final awakening? 6:30 a.m.

5. What time did you

7 a.m.
get out of bed for the
day?
6. Time in Bed
(#5 minus #1) 8.5 hours

7. Total Time Asleep

(#4 minus #2 minus #3) 5.5 hours

8. Sleep Efficiency
(Time Asleep ÷ Time 65%
in Bed)
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your  Poor □Poor □Poor □Poor □Poor □Poor □Poor □Poor
sleep? □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. In total, how long
did you nap or doze 45 min
yesterday?
11. Comments
(if applicable) I have a cold

Didn’t wear
c-pap

8
Session 2

Sleep Efficiency: Reclaiming the bed for sleep

Purpose of today’s meeting:

1. Assignment review
2. Problem solve any difficulties in completing sleep logs
3. Learn about Sleep Efficiency and Stimulus Control (Bed = Sleep)

I. SLEEP EFFICIENCY THERAPY

 One goal when treating your insomnia is to improve your Sleep Efficiency
 Sleep Efficiency = Time Asleep ÷ Time in Bed
1. If you spent 4 hours asleep and 8 total hours in bed last night, your sleep
efficiency would be 4 ÷ 8, or 50%
2. Our goal is to increase the percentage of time you spend asleep in bed
3. One way to do this is to limit the time you spend in bed

II. Sleep Drive

 Sleep is regulated by our brain based on how long we have been awake
 The longer we’re awake, the more “sleep drive” we build up and the sleepier we get
 Sleeping in or napping may help a little that day, but it decreases your sleep drive
and makes it harder to sleep that night

III. What does this mean for Treatment? Your first change!
 Only stay in bed as long as you are typically able to sleep
1. At first, you will get even less sleep than normal
2. But, this will help increase your sleep debt and make it easier to fall asleep
the next night
3. Sometimes with insomnia, you need 2 or 3 nights of added sleep debt
before you fall asleep quickly
4. You may have noticed this pattern in your insomnia already - a few bad
nights followed by a good night

IV. The mind-body relationship

 Certain habits cause our body and our mind to have automatic responses. In other
words, behaviors become associated with feelings and bodily reactions.

Q. Think about when you are lying in bed and can’t sleep.
1. How do you feel?
2. What do you usually do?

 This example shows us how feelings, behaviors, and body reactions can become
associated with each other.
1. When you are in bed awake, you may feel frustrated and restless, be unable
to sleep, and stay in bed trying to sleep more. This experience associates

9
 bed/bedtime with negative feelings. The more negative the feelings, the less
likely you’ll get to sleep.

V. Bad associations with the bed

 One of the major problems in insomnia is that the bed/bedtime is no longer paired
with feelings of relaxation and falling asleep easily
 Instead of Bed = Sleep, for insomniacs Bed = Awake (and often frustrated)
 Q. Think about other examples of things that have led to this problematic pairing of
Bed = Awake for you.
1. What thoughts do you have as you lay awake in bed?
2. How does that make you feel?
3. Does that make it easier or harder to fall asleep?

VI. Stimulus Control strategies: How to make Bed = Sleep again

 Go to bed only when you are sleepy.

1. How do you know when you are sleepy? How is this different from being
physically tired?
2. If you are not sleepy when you go to bed, you might toss and turn, lying in
bed awake. This reinforces the negative association we are trying to break.

 Only use your bed for sleep (or sex).

1. For example, if you watch TV in bed every night until you fall asleep, what
does the bed become associated with? TV watching…not sleep!

 Leave the bed when you are unable to fall asleep after about 15 minutes.
1. Go back to bed only when you feel sleepy again.
2. Repeat this as many times as needed. This will strengthen the association
between bed and sleep (versus bed and awake).
3. The goal is to make the bedroom/bed associated with falling asleep
4. If you do need to leave the bed because you are unable to sleep, try not to
do anything stimulating. Do not check your cell phone, watch television, get on
the computer, or read. Remain as minimally stimulated as possible so as to
promote sleepiness.

 Hide the clock.

1. Looking at the clock (or cell phone) when you cannot sleep is likely to
increase frustration that you are not asleep.
2. Plus, who cares what time it is? You really just want to be asleep no matter
what time it is, right?

10
 Wake up at a regular time regardless of how well or how long you slept.
1. Get out of bed immediately after you wake up. This will help your body to
get into a constant sleep rhythm.
2. If possible, give yourself sunlight or very bright indoor light first thing in
the morning.

 Avoid/reduce naps
1. By not napping, you help to ensure that any sleep debt from last night will
increase your likelihood of falling asleep quickly tonight.

Exercise:
1. Determine your average Total Sleep Time from your sleep log: ___________

a. This is how much Time in Bed you get to spend this week

2. Decide your Wake Up Time: _____________

3. From that, determine your Bed Time: _____________

4. Determine your Sleep Efficiency (Time Asleep ÷ Time in Bed): _____________

a. This will help you see how much you improve.

Assignment:
1. Continue to complete the sleep logs
2. Keep a set “Time in Bed” window: Go to bed consistently at your Bed Time
and set an alarm to get up consistently at your Wake Up Time
3. Follow Sleep Guidelines (Refer to Guide to Overcoming Insomnia)
4. What might make these changes difficult?

11
 Sleep log
Sample
Today’s date Mon Calculated
1/1/12 Averages
1. What time did you
get into bed? 10:30 p.m.

2. About what time did

you fall asleep? 12 a.m.

3. In total, about how

long were you up in the 1 hour
middle of the night?
4. What time was your
final awakening? 6:30 a.m.

5. What time did you

7 a.m.
get out of bed for the
day?
6. Time in Bed
(#5 minus #1) 8.5 hours

7. Total Time Asleep

(#4 minus #2 minus #3) 5.5 hours

8. Sleep Efficiency
(Time Asleep ÷ Time 65%
in Bed)
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your  Poor □Poor □Poor □Poor □Poor □Poor □Poor □Poor
sleep? □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. In total, how long
did you nap or doze 45 min
yesterday?
11. Comments
(if applicable) I have a cold

Didn’t wear
c-pap

12
Session 3

Sleep Hygiene Behaviors

Purpose of today’s meeting:

1. Review Sleep Log and adjust Time in Bed Window
2. Review Stimulus Control Strategies (Bed = Sleep)
3. Problem solve any difficulties
4. Review Sleep Hygiene: how your behaviors can make sleep easier at night and
being awake easier during the day

1. Review Sleep log and Adjust Time in Bed Window

a. If last week’s average sleep efficiency > 85%:
i. Increase Time in Bed by 15 minutes
b. If last week’s average sleep efficiency < 80%:
i. Decrease Time in Bed by 15 minutes
c. Otherwise, maintain Time in Bed Window
2. Review Stimulus Control Strategies (Bed = Sleep)
a. Break association between bed and responses such as frustration, anxiety,
wakefulness, etc.
b. Strengthen association between bed and sleep.
3. Problem solve any difficulties adhering to Time in Bed window/Stimulus
Control strategies
4. Review Sleep Hygiene
a. Examine how your behaviors can make sleep easier at night and being
awake easier during the day

13
Exercise:

Q. What are 2-3 rules of Sleep Hygiene that you are breaking and how can you fix that?

Sleep Hygiene Problem Solution

Is My Solution SMART?
• Specific and small
• Measurable
• Action oriented
• Realistic
• Time stamped

Example SMART Goal: “Each night, I’ll leave my bedroom if I’m awake for 20 minutes or
more” or “On Tues and Thurs morning of this week I will exercise (take a walk) for 20
minutes”.

Assignment:

1. Adjust your Time in Bed window, if necessary

2. Continue to complete the sleep log
3. Practice Sleep Guidelines strategies (Refer to Guide to Overcoming Insomnia)
a. In particular, practice your sleep hygiene solutions

14
 Sleep log
Sample
Today’s date Mon Calculated
1/1/12 Averages
1. What time did you
get into bed? 10:30 p.m.

2. About what time did

you fall asleep? 12 a.m.

3. In total, about how

long were you up in the 1 hour
middle of the night?
4. What time was your
final awakening? 6:30 a.m.

5. What time did you

7 a.m.
get out of bed for the
day?
6. Time in Bed
(#5 minus #1) 8.5 hours

7. Total Time Asleep

(#4 minus #2 minus #3) 5.5 hours

8. Sleep Efficiency
(Time Asleep ÷ Time 65%
in Bed)
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your  Poor □Poor □Poor □Poor □Poor □Poor □Poor □Poor
sleep? □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. In total, how long
did you nap or doze 45 min
yesterday?
11. Comments
(if applicable) I have a cold

Didn’t wear
c-pap

15
Session 4
Sleep and Your Thoughts

Purpose of today’s meeting:

1. Review Sleep Log.
2. Problem solve any difficulties in following Sleep Guidelines (Refer to Guide to
Overcoming Insomnia)
3. Learn how thoughts can influence your sleep

Myths and Truths about sleep

MYTH: I need 8 hours of sleep to survive

Truth: Different people need different amounts of sleep. Most people benefit from
about 7-8 hours of sleep each night, others more and others less.

MYTH: If I don’t get a good night’s sleep, then … (something terrible will happen)

Truth: How many bad nights have you had? How many times has this terrible thing
happened? Does it happen 100% of the time?

MYTH: If I am having trouble sleeping, I should try harder to sleep

Truth: Trying harder usually works in reverse - it makes it less likely you will fall
asleep, because you make yourself more alert and frustrated

MYTH: If I had a bad night of sleep, I should try to catch up (by sleeping in, by spending
more time in bed)

Truth: Spending more time in bed rarely provides you with quality sleep and only
increases the chances you will sleep poorly the next night. On the other hand, if you
get out of bed even when you did not get enough sleep, you will be a little sleep
deprived the next night and therefore more likely to fall asleep quickly.

16
Exercise: Challenging sleep thief thoughts
1. What are some unhelpful thoughts you have about sleep and how can you challenge
them?

Sleep thief thought Alternative thought

Example: “If I can’t get a good “Even if I don’t sleep well tonight, I can still get up
night’s sleep my day tomorrow will in the morning and do things. And the more active I
be shot” am tomorrow, the easier it will be to fall asleep
tomorrow night.”

Exercise: Scheduled Worry Time

2. Research shows that scheduling “worry time” can help contain worry and anxiety.
Pick a set time every day, at least 3 hours before bedtime, when you can worry for 15-30
minutes. During this set time, write down all of the worries that come to mind, and feel
free to engage in constructive problem solving if there are any actionable steps you can
do to address the worry. If not, move on to the next worry. When a worry pops up right
before bedtime or in the middle of the night, tell yourself to DELAY this worry until your
set worry time.

Assignment:

1. Adjust your Time in Bed Window, if necessary

2. Continue to complete the sleep log
3. Practice Sleep Guidelines strategies (Refer to Guide to Overcoming Insomnia)
4. Pay attention to thoughts that might be interfering with your sleep and see if you can
come up with more helpful alternative thoughts

17
 Sleep log
Sample
Today’s date Mon Calculated
1/1/12 Averages
1. What time did you
get into bed? 10:30 p.m.

2. About what time did

you fall asleep? 12 a.m.

3. In total, about how

long were you up in the 1 hour
middle of the night?
4. What time was your
final awakening? 6:30 a.m.

5. What time did you

7 a.m.
get out of bed for the
day?
6. Time in Bed
(#5 minus #1) 8.5 hours

7. Total Time Asleep

(#4 minus #2 minus #3) 5.5 hours

8. Sleep Efficiency
(Time Asleep ÷ Time 65%
in Bed)
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your  Poor □Poor □Poor □Poor □Poor □Poor □Poor □Poor
sleep? □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. In total, how long
did you nap or doze 45 min
yesterday?
11. Comments
(if applicable) I have a cold

Didn’t wear
c-pap

18
Sessions 5+

Titration and Compliance

Additional sessions (Sessions 5+) may be warranted to work on titration and compliance.
More specifically, additional sessions (usually 1-3 total) may be indicated if:

1. Sleep Efficiency is not yet greater than 90%

a) If so, further titration, or adjustment in patient’s time in bed

window, may be needed.

2. Patient needs additional sessions to work on compliance with sleep

hygiene guidelines

a) If within provider’s scope of practice, it may be helpful to

address other behavioral health issues impacting compliance (e.g.,
anxiety, depression, pain).

19
Session 6
Relapse Prevention
Action Plan for Addressing Insomnia in the Future
Insomnia can return but now that you know how to address it, you don’t need to panic if
it does. Recognize that you will have occasional bad nights. Check the parts of this
treatment that have worked well for you (even those that were difficult to follow) and use
them when you re-experience insomnia.
Keeping the same wakeup time every day
Going to bed when you’re sleepy but never before your regular bedtime
Using the bed for sleeping only
Getting out of bed:
when you’re unable to sleep
when you find yourself worrying or can’t shut off your thoughts
at the same time every day, even if you’ve had a bad night’s sleep
Creating a buffer zone before bed
Engaging in worrying or problem solving earlier in the day
Reframing your sleep thief thoughts
Not trying too hard to sleep
No napping (except for short safety naps)
Avoiding caffeine, alcohol, cigarettes, or vigorous exercise within a few hours
bedtime
Other: __________________________________________________________

Two Commandments of Maintaining Success:

1. Don’t stay in bed awake for more than 15 minutes

a. Or upset, frustrated, or even just alert

2. Don’t compensate for a bad night

a. Don’t turn in early, stay in bed later, or nap
b. I may sleep poorly tonight but tomorrow night I’m increasingly likely to
sleep better.

20
If you notice new sleep-related problems, please contact your doctor and schedule an
appointment. Such problems can include:

 loud snoring
 stopping breathing, breathing pauses, gasping or snorting during sleep
 falling asleep unintentionally/dozing during the day
 a creepy-crawly sensation in your lower legs in the evening along with an
irresistible urge to move your legs to get rid the sensation
 very frequent leg jerking during your sleep
 walking or the urge to walk while asleep
 excessive weight gain or loss
 chronic repeating nightmares
 feelings of panic disrupting your sleep
 any other unusual new sleep experiences

21
 Sleep log Name:________________________________
Sample
Today’s date Mon Calculated
1/1/12 Averages
1. What time did you
get into bed? 10:30 p.m.

2. About what time did

you fall asleep? 12 a.m.

3. In total, about how

long were you up in the 1 hour
middle of the night?
4. What time was your
final awakening? 6:30 a.m.

5. What time did you

7 a.m.
get out of bed for the
day?
6. Time in Bed
(#5 minus #1) 8.5 hours

7. Total Time Asleep

(#4 minus #2 minus #3) 5.5 hours

8. Sleep Efficiency
(Time Asleep ÷ Time 65%
in Bed)
9. How would you rate □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor □ Very poor
the quality of your  Poor □Poor □Poor □Poor □Poor □Poor □Poor □Poor
sleep? □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair □ Fair
□ Good □ Good □ Good □ Good □ Good □ Good □ Good □ Good
□ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good □ Very good
10. In total, how long
did you nap or doze 45 min
yesterday?
11. Comments
(if applicable) I have a cold

Didn’t wear
c-pap

22
23