2nd Act Health & Testing Services — Sleep Lab

Sleep Tracking Log

This log records your sleep over several nights so we can see patterns rather than a single night. Complete it each morning — it takes about a minute. Your entries save automatically, so you can close this page and return tomorrow.

Step 1 of 2

About You

A few details before we begin.

Your Details

Completed once, at the start.

First name * Last name * Email * What phase are you in? * Start date (first night tracked) * Number of days to track *

Your practitioner will tell you which to choose.

Current Status

Asked once. Tell your practitioner if this changes during tracking.

Are you sick or recovering right now? *

Please describe

Do you use a CPAP machine?

Yes No

Step 2 of 2

Your Nightly Entries

Complete each morning for the night before.

Day 1

Answer for last night / yesterday.

How was your day? *

1 2 3 4 5

BadAverageGreat

Anything that stood out? (tap all that apply)

Lots of stress No energy A lot on my mind Physically unwell Pain

How much exercise did you do? * How many hours did you sit? * Time you went to sleep * Time you woke up (final) * Number of times you woke during the night *

What times did you wake up?

Quality of sleep * Did you use your phone or any device 45 minutes or closer to bedtime? *

Yes No Do not recall

Total screen time before bed How much of this was gaming?

Did you use anything to help you sleep? *

Specify name / ingredients

Did you engage in any of these? (tap all that apply) *

none naps during day alcohol cannabis (self rolled) cannabis vape cannabis tincture cannabis gummy smoking (one or two cigarettes) smoking (more than 2 cigarettes) vaping nicotine (1 to 2 times) vaping nicotine (more than 2 times) other drugs (list below)

Notes (elaborate on anything above)

Finished?

Your sleep log has been received.

Thank you — your practitioner will review this before your next appointment.

You may now close this page.

Saved on this device