TODAY'S DATE | |||||||
1. Last night, I took sleep medication. (yes or no) | |||||||
2. What time did you go to bed last night? | |||||||
3. After turning the lights off, how long did it take you to fall asleep? | |||||||
4. How long were you awake during the night? | |||||||
5. What time did you wake up this morning? (your last awakening in the morning) | |||||||
6. Overall, my sleep last night was___ : 1=very restless 2=restless 3=average quality 4=sound 5=very sound |
COMMENTS: