Sleep diary

CBT-I (cognitive behavioural therapy for insomnia) depends on accurate sleep data. The protocol’s interventions (sleep restriction, stimulus control, cognitive restructuring around sleep) only work if you know what’s actually happening in the client’s nights. Most clients arriving with sleep complaints have a vague verbal summary of the problem (“I sleep badly”, “I can’t fall asleep”, “I’m exhausted”) that doesn’t translate into the specific patterns CBT-I targets.

This worksheet runs a structured fortnight of nightly entries. Bedtime, time to fall asleep, awakenings, total hours, the methods the client tried (screens, alcohol, melatonin, exercise, breathing), and how they felt the next day. Two weeks is the minimum. One week of data isn’t enough to separate signal from variance. By the end of week two the patterns are usually clear.

Use it for any insomnia presentation, for hypersomnia, and for sleep complaints alongside mood or anxiety disorders. Use it also for clients who report their sleep is “fine” but present with daytime fatigue and low mood. The diary often surprises them. They’re sleeping less than they think, or sleeping plenty but waking unrefreshed, which points at different protocol routes.

The clinical move at submission review. The methods column is where the actual conversation lives. Clients trying to manage sleep with phones-in-bed, alcohol, daytime napping, or weekend sleep-extension are reporting what’s maintaining the problem. None of those are sustainable solutions, and the data shows it across two weeks. The conversation in session is which one to address first.

The other lever is the gap between hours slept and reported tiredness. Clients sleeping seven hours and reporting exhaustion every day are not sleep-deprived in the textbook sense. Sleep restriction won’t help them. Something else is going on: poor sleep quality from fragmentation, depression-related fatigue independent of sleep, undiagnosed apnoea, or thyroid issues warranting a medical referral. The diary surfaces this distinction quickly.

A pattern to catch: clients whose entries cluster bedtimes that are rotating across the week (11pm one night, 2am the next, midnight the following). That circadian instability is a separate clinical target from initiation insomnia, and the protocol differs.

In my-cbt, the worksheet is one of the bundled system templates. Assign it for two weeks with a personal message asking the client to fill it in within five minutes of waking, while the night is still in their memory. Submissions save with timestamps and you can read fourteen nights of data in three minutes before next session.