Agenda du sommeil - version anglaise

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Sujets

• Médecine

Informations

• Publié par: haute-autorite-sante
• Nombre de lectures: 124
• Licence : En savoir +
  Paternité, pas d'utilisation commerciale, partage des conditions initiales à l'identique
• Langue: English

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Your sleep diary

Start filling out the 1 st line D1 with your doctor

Last name:……………………

First name: …………………

Date: ….. / ……

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M.S. took ½ ZOLPIDEM, went to bed at 7.30 p.m., fell asleep at 9 p.m. after watching TV, slept until 7 a.m., with sleep interrupted by waking between midnight and 1 a.m. – M.S. went back to bed for a nap at 1.30 p.m. and slept from 3 to 4 p.m. and then got up. The quality of sleep and wellness were poor.

Sleep-inducing medication

Name of medication……………… …………………………………………… …………………………………………

..

. ....

Write down what you have taken each night to help you sleep in the “medication” column

Time spent in bed or sleeping (night, daytime nap)

Mark with an “X”: - the time you went to bed - the time you got up

Show the time spent asleep by shading the box:

Quality of sleep and wellness during the day

Note the quality of sleep and wellness during the day using: G poor= good P = VG = very good VP = very poor

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