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Your guide to sleep diaries for CBT

Here’s how sleep diaries can help your clients achieve better rest.

Ryan DeCook
Ryan DeCook, LCSWTherapist

Worksheets and structured tools are powerful assets in therapy. They offer clients a tangible way to engage with treatment, build insight, and track progress over time. Whether addressing mood, anxiety, or sleep, these tools provide clarity and structure to the therapeutic process. One particularly effective worksheet used in Cognitive Behavioral Therapy for Insomnia (CBT-I) is the sleep diary. It is a simple yet powerful intervention that gives the client and the therapist valuable insights into sleep habits and patterns.

What is a sleep diary?

The sleep diary is a core part of the CBT-I treatment protocol. CBT-I seeks to improve sleep patterns for clients suffering from a variety of sleep challenges. The treatment includes psychoeducation, cognitive interventions, and behavioral interventions including sleep hygiene practices. The sleep diary is introduced in the initial sessions of CBT-I and gives the client a way to track multiple aspects of their sleep patterns. Clients are asked daily to record the data about their previous night’s sleep. There are various prompts on the worksheet that help clients and their therapist identify unique aspects of their sleep patterns and tailor targeted interventions for those challenges. 

Initially, the client tracks their sleep for 1-2 weeks to establish a baseline of their current sleep. Insights from the sleep diary can lay the foundation for change with the client. The sleep diary is used through CBT-I treatment because it sustains client engagement, shows the progress of interventions, and highlights any needed treatment adjustments. As interventions like sleep restriction and stimulus control are applied, the client and therapist can tangibly see the results. Overall, a therapist and their client use a sleep diary to inform treatment plans and interventions used in session.

Sleep diary questions

A typical sleep diary includes the following questions to track sleep patterns:

  • What time did you get into bed?
  • What time did you try to go to sleep?
  • How long did it take you to fall asleep?
  • How many times did you wake up, not counting your final awakening?
  • In total, how long did these awakenings last?
  • What time was your final awakening?
  • After your final awakening, how long did you spend in bed trying to sleep?
  • Did you wake up earlier than you planned? (Yes/No) If yes, how much earlier?
  • What time did you get out of bed for the day?
  • In total, how long did you sleep?
  • How would you rate the quality of your sleep? (e.g., Very poor, Poor, Fair, Good, Very good)
  • How rested or refreshed did you feel when you woke up for the day? (e.g., Not at all rested, Slightly rested, Somewhat rested, Well-rested, Very well-rested)
  • How many times did you nap or doze?
  • In total, how long did you nap or doze?
  • How many drinks containing alcohol did you have?
  • What time was your last drink?
  • How many caffeinated drinks (coffee, tea, soda, energy drinks) did you have?
  • What time was your last caffeinated drink?
  • Did you take any over-the-counter or prescription medication(s) to help you sleep? (If yes, list medication(s), dose, and time taken)

Sleep diary instructions

Clients should fill out the sleep diary daily. It is suggested that they input most of the information in the mornings when they can still remember the details of the previous night. Several key metrics can be identified through sleep tracking. These help establish a baseline of a client’s sleep and monitor progress throughout treatment. 

Total time in bed (TIB): This is the period from when a client gets into bed for the evening to when they get out of bed for the day. 

Time awake: This is determined by identifying the total time spent between initial bedtime and final time of getting out of bed for the day. This considers wake windows during the middle of the night. Time awake = Sleep onset latency (how long it takes to fall asleep) + total minutes awake during the night + minutes awake after final awakening but before getting out of bed. 

Time asleep (TST): This calculates the total amount of time that the client actually was asleep during the night. It subtracts time awake from the total time in bed. Time asleep = total time in bed - time awake.

Sleep efficiency (SE): This calculation takes the time asleep, divides it by the total time in bed, and multiplies it by 100 to determine a percentage of sleep efficiency. SE = (TST/TIB)x100. Generally a sleep efficiency of 85% or higher is considered healthy. 

Sleep diary PDFs

This list includes a few different versions of sleep diaries that can be utilized with clients:

Headway’s resources help you better serve your clients.

While sleep diaries help you gain insight into your patient's behavioral patterns, Headway helps you manage the minutia of your practice. Headway empowers therapy practices by handling administrative and insurance-related tasks, allowing providers like you to focus more on client care. Its intuitive platform centralizes scheduling, documentation, and insurance claims, streamlining your workflow and reducing time spent on paperwork. With integrated template management and digital delivery tools, Headway helps you stay organized and efficient. 

Providers benefit from a comprehensive suite of free EHR features, including built-in documentation, assessments, and tools for securely storing and sharing essential forms. By minimizing administrative burdens, Headway enables you to dedicate more attention to your clients.

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