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N3335 Promoting Healthy Lifestyles

N3335 Promoting Healthy Lifestyles



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Assignment: Sleep Log


Submit 2359 Saturday of Module 2

Name:   Date:  


Overview: Sleep Log

You will maintain a Sleep Log for the first week of the course in preparation for studying the role of sleep in health promotion during Module 2. This document enables you to record how much sleep you get in each 24-hour period and your “sleepiness factor” when you are awake.

Example of input for Nighttime Sleep Total (hrs:min) – 7:25 (means you slept for 7 hours and 25 minutes)



· Analyze personal sleep patterns.




Use this rubric to guide your work on the assignment “Sleep Log.”

Task Accomplished Competent Needs Improvement
Sleep log for 1 week

(Total 100 points)

All parts complete, i.e. No Blank Boxes

(100 points)

Most parts complete (50% or more, but less than 100%)

(75 points)

Less than 50% complete

(0 points)




Sleep Log

Nighttime* sleep total


Napping sleep total

hrs:min (or 0)

Levels of sleepiness

0 = Wide awake

1 = Slightly sleepy

2 = Moderately sleepy

3 = Very sleepy

4 = Falling asleep/sleeping













Difficulty staying awake

0 = Not at all

1 = Occasionally

2 = Frequently

3 = Most of the time

4 = All the time


Meal times (M) and Snack times (S)

Enter all your meal and snack times


Ex) 0830 (M); 1315 (S); 1700 (M)




Medication that could cause drowsiness (Y or N)              
Unusual circumstances that may have affected sleep (Y or N) If yes, please briefly explain              

* If your work schedule requires you to work during the night and sleep during the day, record daytime sleep hours instead of nighttime sleep hours.




©2016 UTA College of Nursing and Health Innovation

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