Universal · Behavioral

Sleep Hygiene Worksheet

A 10-habit checklist plus a 3-habit commitment

therapistassist.app

Sleep hygiene is the set of daily habits that make sleep more likely. Pick three to commit to this week — not all ten.

Same wake time every day (within 30 min)No screens 60 min before bedNo caffeine after 2pmBedroom cool, dark, quietBed used only for sleep and sexOut of bed if awake >20 minDaylight within 1 hour of wakingNo long daytime napsWind-down routine 30–60 min before bedNo alcohol within 3 hours of bed

Three I will commit to this week

What gets in the way — and my plan for it

How I will know it is working

About this worksheet

The sleep hygiene worksheet is the client-facing companion to the sleep hygiene checklist — a two-week tracker that turns the recommendations into a lived experiment. The top of the page names the client's committed wake time and wind-down window. The middle logs each night's actual bedtime, wake time, and adherence to the two hygiene changes the client picked with their therapist. The bottom captures caffeine, alcohol, screen use, and any daytime nap, so client and therapist can see which variables actually track with better or worse nights. Sleep interventions fail when they stay abstract; the worksheet exists so both parties can look at a real two-week pattern in the next session rather than argue about what the client remembers. Pair with the sleep hygiene checklist for the psychoeducation and the CBT-I sleep diary if the client needs full stimulus control and sleep restriction.

When to use it

After the sleep hygiene psychoeducation is in place and the client has picked their first two changes.
For clients who describe poor sleep but can't say which nights were worse or why — the tracker surfaces the pattern.
As a between-session accountability structure — filling in each day takes 90 seconds.
As a bridge to full CBT-I when hygiene alone isn't enough — the worksheet data feeds the sleep restriction calculation.

How to use it

1
Set the wake time anchor
Client and therapist agree on a fixed wake time, seven days a week, that fits the client's real life. It goes at the top of the sheet.
2
Name the two changes being tracked
Not ten. Two. The two the client picked from the sleep hygiene checklist that they actually intend to try.
3
Fill in each morning
Bedtime, wake time, sleep quality 0–10, plus adherence to the two changes and yesterday's caffeine, alcohol, screens, naps.
4
Bring it back in two weeks
Review the pattern together. Which nights were worse? What was different about those days? Adjust the plan from the data, not the memory.

Frequently asked questions

How is this different from a sleep diary?+

A sleep diary logs sleep. This worksheet logs sleep plus the specific hygiene changes the client is trying, so you can see whether the changes moved the numbers. Diaries and this worksheet often live side-by-side in early CBT-I.

How long should the client track?+

Two weeks is the minimum window that reveals a pattern. Anything less than a week is noise. If the client falls off mid-week, restart the two-week clock.

Should I include naps?+

Yes, always. Long or late naps are a common hidden reason for poor overnight sleep, and the client often doesn't connect the two until the tracker shows it side by side.

Is this worksheet free?+

Yes. Free printable PDF for clinicians. Sign in to TherapistAssist to send it as a secure client link or add your practice name.

Related worksheets

Universal

Sleep Hygiene Checklist

Worksheet — Sleep Hygiene Worksheet — provided by TherapistAssist for clinical use. Not a substitute for assessment or treatment.