1.What time did you wake up today? 6:50am
2.What time are you lying down to go to sleep? 10:45
3.What, if any, was your bedtime routine? read a book with no noise and lamp on.
4.What were the last food(s) you consumed tonight? (Include type, amount, and time you ate.) Cold cut hoagie and pumpkin latte
5.Did you exercise today? (Include the type, duration, and time of day if you exercised.) No
6.Did you consume any alcoholic beverages today? (Include type, number, and time of day.) No
7.Did you consume any caffeinated drinks or foods today? (Include type, number, and time of day.) Yes 2 cups of coffee in the morning, pumpkin latte around 8:30pm
8.Did you take any medications (prescription and/or over-the-counter) today? (Include type, amount, and time of day.) yes blood pressure, calcium, prilosec and multivitamin
9.Did you take any naps today? (Include number of naps, duration of each, and time of day.) 1 from 10am to 12:30pm
10.What types of stressors did you encounter today, and what types do you expect to encounter tomorrow? None really, not sure
11.How hungry did you feel today? (1- Not hungry, 2- Normal hunger, 3- Strong hunger, 4- Extreme hunger) 1
12.How awake did you feel today? (1- Exhausted, 2- Somewhat tired, 3- Fairly alert, 4- Wide awake) 1
13.How irritable did you feel today? (1- Calm, 2- Slightly annoyed, 3- Moderately irritable, 4- Highly irritable)3

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Next, draw a line of Zzz's across the page beneath your answers to these questions. When you wake up, answer the following questions below your "sleep" line:
1.How long did it take you to fall asleep last night? (This may be an estimate.) 45 minutes
2.How many times did you wake up during the night? (Include times you woke up and how long you stayed awake.) 2 the first time probably 10 minutes the second I got up.
3.In total, how many hours did you sleep last night? Approximately 5 1/2.