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My CBTI Sleep Diary
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* Indicates required question
Enter Your Name
*
Your answer
In total, how long did you nap or doze yesterday?
Hrs
:
Min
:
Sec
What time did you get into bed?
Time
:
AM
PM
What time did you try to go to sleep?
Time
:
AM
PM
How long did it take you to fall asleep?
Hrs
:
Min
:
Sec
How many times did you wake up, not counting your final awakening?
1
2
3
4
5
Other:
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In total, how long did these awakenings last?
Hrs
:
Min
:
Sec
What time was your final awakening?
Time
:
AM
PM
Did you wake up earlier than you planned?
Yes
No
Clear selection
If yes, how many minutes earlier?
Hrs
:
Min
:
Sec
What time did you get out of bed for the day?
Time
:
AM
PM
How would you rate the quality of your sleep?
Very Poor
Poor
Fair
Good
Very Good
Clear selection
Comments (if applicable)
You can say things like "I had a cold".
Your answer
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