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I was recently talking with a friend who had asked me for suggestions regarding his poor sleep. One of the first recommendations I made to him (as well as to almost anyone who comes to see me) was to "track your sleep." He then looked at me with a puzzled look on his face, and said "How? I should be sleeping, what do you mean track your sleep?" His comment made me think more about what it means to track your sleep since I find that many specialists tell patients to do the same, but oftetimes guidance isn't given about how exactly to track those restless nights.
Properly tracking your sleep can yield lots of information for both you and your treatment provider. Whenever I see a patient in my practice, I always ask that the patient fills out a sleep diary for the two weeks before we meet (I mail or email them the diary to fill out). I also have my patients continue using the sleep diary throughout treatment to see how simple changes can result in drastic improvement in the quantity and quality of their sleep, as well as increasing daytime energy.
There are many types of sleep diaries and a simple Internet search can even be confusing. There are even smartphone apps that have sleep diaries. However, it is extremely easy to keep a log yourself, and I have many patients who track their sleep in a journal or even on their phone. Figure out the best method of data collection for you and stick with it.
The best sleep diaries contain basic information about both the day and the night. They should take 1-2 minutes to fill out and in no way should increase stress levels and frustration about bed. They should be brief so you can see the data and make any associations possible without sifting through paragraphs.
Step #1: Start an entry just before bed each night. Think about your day and write down the following information: how much energy you had on average for the day, and what time you consumed any alcohol, caffeine and tobacco (and the amounts). Write down any naps (and how long they were) as well as any medications you took. Write down any stressful (out of the ordinary) events that happened that day. Finally, write down the time that you decided to go to bed for the night. Many people like to create a quick Excel spreadsheet that lists various data points in each column. For example, have a column for caffeine (yes/no, time of day), one for exercise (yes/no, time), one for bedtime, one for naps (yes/no, time).
Step #2: When you get up the next morning, think about how you slept the night before. Estimate how long it took you to fall asleep, how many times you woke up in the middle of the night and how long you were up for each time. Write down what time you woke up as well as what time you got out of bed. Finally, write down how you felt when you woke up. You can do columns here as well as noted above.
The most important tip that I stress to everyone is to NOT fill out the diary in the middle of the night. Looking at the clock at night since it only serves to worsen sleep. Let go of the pressure to be exact—simply estimate the times you might be awake at night. You can usually tell the difference between being up for 20 minutes versus two hours.
Keeping a sleep diary is a key first step in making any necessary changes to your sleep. Basic changes to proper sleep hygiene can make a world of difference for some patients. Look for trends on your sleep diary. For example, you might notice that taking a nap during the day might lead to trouble falling asleep at bedtime. Some people find that sleeping in on the weekends makes it harder to fall asleep on Sunday night. Others may notice that exercise too close to bedtime impacts their ability to fall asleep. A sleep diary can make it easy to pinpoint things that need to be changed.
It is best to track your sleep for two weeks in a row. Everyone has a bad week of sleep here and there, so observing two week's worth is best. Once you've done the baseline tracking, you can then try to make some simple changes. Here's some basic sleep hygiene changes that many people can make after looking at their sleep diary. Track your sleep for another two weeks once making sleep hygiene changes and see what happens.
Proper sleep hygiene includes:
1. Keep a consistent bed and wake time every day, seven days a week.
2. Keep your bedroom quiet, dark and cool.
3. Avoid alcohol, tobacco, heavy meals, liquids and exercise within three hours of bedtime.
4. Avoid caffeine after 2 p.m.
5. Avoid naps, especially after 2 p.m.
6. The bed is only for sleep and sex. If you can't sleep, get out of bed and do something calm, quiet and relaxing in a dimly lit room. Return to bed only when sleepy.
7. Power down (turn off TV, iPads, iPhone, computers) one hour before bed and wind down with relaxing activities (reading, knitting, stretches, listening to music) in dim light.
After another two weeks of sleep diary data with proper sleep hygiene, look and see what happened. If, despite making the above changes, you still have trouble falling asleep, staying asleep or feeling unrefreshed during the day, consider making an appointment with a sleep specialist. There are many effective options for insomnia (e.g. Cognitive Behavior Therapy for Insomnia), and a sleep specialist will find it extremely helpful if you've already begun tracking your sleep.
