You’ve started waking up during the night, you’ve noticed you’re more tired during the day and you’re a lot more irritable than usual. Your doctor recommends seeing a sleep medicine specialist who recommends you keep a sleep diary.
You naturally ask yourself, how much is a journal going to help my sleep?
Potentially a lot, says Matthew Ebben, PhD, a psychologist in the Department of Neurology and Neuroscience at NewYork-Presbyterian and Weill Cornell Medicine who specializes in sleep medicine. “In the most general terms, a sleep diary is a record of how someone is sleeping at night — and people tend to keep one because they have some kind of sleep problem at night.”
It’s the first course of action most sleep specialists take when they see a new patient with a sleep problem, Ebben adds. If a sleep specialist suggests you keep a sleep diary (also sometimes called a “sleep log”), expect to track a lot more than just what time you went to bed and what time you woke up. Being aware of diet, caffeine and alcohol intake, exercise, medications you take (OTC and prescription) and if and when you feel tired or fatigued throughout the day may all be included.
“It’s a wealth of information,” Ebben says. And they really do help people find and fix sleep problems, he adds.
Experts across the field of sleep medicine agree. In 2012 a coalition of insomnia researchers and other sleep experts developed a consensus sleep diary, which included endpoints other research found were most helpful for identifying and fixing insomnia and other sleep problems.
Generally when people come in complaining about a sleep problem, it’s a subjective problem. They complain about feeling fatigued during the day or having trouble staying asleep at night, Ebben says. “A sleep log is a great way to document what someone is feeling about their sleep quality and see if that improves over time.”
Here’s a few other helpful pointers about sleep diaries — and how to use them effectively to help you sleep better:
1. Sleep doctors ask patients to keep sleep logs all the time
Ask Ebben how often he has one of his patients keep a sleep diary and he won’t hesitate in his reply: “All the time. All the time,” he says.
It’s usually the first recommendation for patients with insomnia, fatigue or some other sleep complaint, Ebben says. It’s a subjective tool, but it can help find objective problems, he explains. Someone may not realize that a caffeine habit or a certain exercise routine is linked to more nighttime awakenings or some other sleep issue. It also helps both doctors and patients understand how sleep changes over time.
2. The details are important!
Again, a sleep diary is about way more than documenting when you fall asleep and when you wake up. A good sleep diary should also include when you first got into bed, when you fell asleep, if and when you woke up during the night, when you first woke up in the morning, when you got out of bed, medications you take during the day, caffeine and alcohol use, if and when you napped, exercise you did and your mood throughout the day.
“Variability in the sleep-wake schedule is one of the most important things we’re looking at,” Ebben says. But it’s also important to track the little things, too (think daytime habits), that might be causing the sleep difficulties, he adds. “There’s a lot that we look for.”
3. Slacking off when it comes to your diary is only hurting you
Self-preservation is human nature. But when it comes to keeping a sleep diary, you don’t get a gold star for giving certain answers over others. Be honest, Ebben says — and track all the details your doctor is asking for. (And in time your reward will be better sleep.)
Some doctors will ask you to keep a diary with a lot of notes about how you’re feeling throughout the day and night. Others will ask you to keep your log in a graph format, Ebben explains. Each part is important for looking at different components of your sleep and overall wellness — and filling it out completely and truthfully is the best way to get the best results.
If not, he says: “You’re only doing yourself a disservice.”
4. No, you’re not going to remember to tell your doc all that info if you don’t write it down
It really does help to write it all down, Ebben says. You think you can remember everything about your sleep — and will be able to recite it back to your doctor — but you won’t, he explains.
“And sometimes people will think things aren’t a big deal, but your sleep specialist will disagree,” he adds — such as sleeping in later than usual a few times a month on weekends. “These little details are important,” he says. “And on a sleep log, you can see them.”
5. You don’t need a doctor’s Rx to reap the benefits of a sleep log
Curious if a sleep diary can improve your sleep? Try it, Ebben says. You don’t need a doctor’s prescription to start tracking your sleep — and sometimes you may even be able to identify your problem areas or space for improvement without a sleep medicine degree, he adds. “Sometimes just by starting to track sleep times, people start to have more regular sleep-wake times. People self-treat.”
Or if you notice a problem and start tracking your sleep before seeing a specialist, your doctor may be able to prescribe or start a treatment for you sooner based on the records you keep, Ebben notes.
You can download BETTER's 7-Day Sleep Diary here. The National Sleep Foundation also offers a free sleep diary template anyone can use, as does the National Heart, Blood, and Lung Institute and the American Academy of Sleep Medicine.
6. You can’t substitute Fitbit data for a well-kept sleep diary
Activity trackers and other sleep monitors track objective measures of sleep — like how restless you are through the night or (in some cases) breathing rhythms or heartbeat. Those measures provide a certain set of data, but self-reported sleep quality offers clinicians other insights about how their patients sleep and how satisfied they are with their sleep.
And those subjective measures of sleep are the ones doctors want to help their patients with because those are typically the ones that keep patients up at night, Ebben says. “We want to address the complaints that [patients] have — not some objective issue that they didn’t even know about until they wore something.”
(Though Ebben adds that in-lab sleep studies shouldn’t be equated with activity trackers and wearables. In-lab sleep tracking methods have been validated by high-quality research — and those can tell doctors other trustworthy measures of sleep, too.)
7. Your doc doesn’t want you stressing over your diary
Sleep diaries can be incredibly useful for discovering patterns — but they’re not meant to sleep-shame you, says Jeffrey Ellenbogen, MD, assistant professor of neurology at the Sleep Disorders Center at The Johns Hopkins Hospital. And keeping one shouldn’t stress you out.
“The only downside I see about sleep diaries is the hyper-focus on timing,” he explains. “Falling asleep requires mental relaxation. Too much focus on the clock and worry is not the goal here.”
Bottom line: Don’t stress out too much about your log. A good sleep diary is about helping you find and improve inconsistencies and potential problems with your slumber. That should make you rest easy.
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