BRING TO YOUR NEXT VISIT
Small notes. A clearer picture of your nights.
A simple sheet for your own observations and anything a partner happens to notice. Use as many or as few of the 14 days as you like.
2 pages · 14 optional days
How to use the diary
Make a short note about the night and the following day when it suits you. Approximate times are fine.
Leave fields blank or write “not sure.” You do not need a wearable, app, or recording.
A partner may note what they happen to notice. No one needs to stay awake to observe.
The print button includes the worksheet below. The PDF is a blank version without your checkmarks. You can also use your browser’s print menu.
No account or submission. Write personal details by hand on your own copy. We do not save your checkmarks.
Week 1
Dates from / to:
My own notes
Describe what you remember. Approximate times are fine. Leave fields blank or write “not sure.”
| Date / day | Went to bed / got up | How did the night feel? | Sleepiness / daily activities the next day |
|---|---|---|---|
| Day 1 | |||
| Day 2 | |||
| Day 3 | |||
| Day 4 | |||
| Day 5 | |||
| Day 6 | |||
| Day 7 |
If a partner wants to contribute
Agree on what to share. Note only what your partner actually heard or saw, such as snoring or possible breathing pauses. A quiet night does not rule out sleep apnea.
| Date | Who noticed what? | What was certain or uncertain? |
|---|---|---|
Anything else I want to mention
For example, an unusual night, illness, or a change in routine. These notes do not establish the cause.
Discuss breathing pauses during sleep or significant daytime sleepiness with your healthcare provider. Do not delay that conversation to complete this sheet. The diary cannot diagnose or rule out sleep apnea.
Week 2
Dates from / to:
My own notes
Describe what you remember. Approximate times are fine. Leave fields blank or write “not sure.”
| Date / day | Went to bed / got up | How did the night feel? | Sleepiness / daily activities the next day |
|---|---|---|---|
| Day 8 | |||
| Day 9 | |||
| Day 10 | |||
| Day 11 | |||
| Day 12 | |||
| Day 13 | |||
| Day 14 |
If a partner wants to contribute
Agree on what to share. Note only what your partner actually heard or saw, such as snoring or possible breathing pauses. A quiet night does not rule out sleep apnea.
| Date | Who noticed what? | What was certain or uncertain? |
|---|---|---|
Anything else I want to mention
For example, an unusual night, illness, or a change in routine. These notes do not establish the cause.
Discuss breathing pauses during sleep or significant daytime sleepiness with your healthcare provider. Do not delay that conversation to complete this sheet. The diary cannot diagnose or rule out sleep apnea.
Explore next
Bring your notes to the conversation
You choose what to share with your healthcare provider. These notes support a conversation; they are not a sleep test.
Appointment guide When your partner snores Understanding sleep testingSources and limits
Original worksheets. NHLBI explains how sleep observations can support a healthcare assessment. These sheets are not a validated screening questionnaire.
Sources checked November 1, 2026