Introduction

Getting adequate sleep is essential to good health. Therefore, tracking a client’s sleep can help provide valuable insights into their well-being. Sleep tracking has become increasingly popular with the availability of wearable technology, but it can also be useful for therapists to observe mental health symptoms. For example, the DSM-5 lists sleep disturbances as symptoms for a variety of mental health disorders [1]. Here, we will describe a method of tracking sleep called a sleep log and explain why it’s a key component of monitoring your client’s progress. Lastly, we will show you how Adhere.ly makes sleep logs easy by utilizing a digital format, reminders, and review features.

‍What is a sleep log?

A sleep log is a method of documenting sleep patterns and determining sleep efficiency. With a sleep log, your client will record what time they got into bed, the time they went to sleep, how often they woke up, how much time they spent awake, what time they woke up, and what time they got out of bed. All of these data are used to calculate a sleep efficiency score, — which is the percentage of the time spent sleeping while in bed. Luckily, Adhere.ly calculates this score automatically. Sleep logs can also be combined with other measures, like heart rate monitors and motion detectors. A sleep study of 30 adults with major depressive disorder found that patients with higher depression scores had a higher difference between their subjective sleep log and a biological sleep-tracker, as participants believed they were getting worse sleep than they were in reality [2]. The researchers concluded that clinicians could utilize objective measures and a sleep log to assess depression severity. It can also help clients recognize the true quality of their sleep. That said, in another study comparing sleep log data with a wrist monitor, there wasis still a significant positive correlation between sleep efficiency calculated in the sleep logs and the data from wrist monitors [3]. Hence, though there may be some discrepancies based on the severity of mental illness, sleep logs are an overall useful measure of sleep health. The number of nights for collecting sleep data can vary on a case-by-case basis. An analysis of 1,766 sleep diary entries concluded that an accurate assessment of adolescent sleep health can be made after at least five weekday nights [4]. The log can be online or on paper, as a pilot study found that an electronic log produced similar results to a paper log [5]. These electronic logs, like the one used by Adhere.ly, might also increase client completion rates since data can be entered anywhere and therapists can send reminders.

‍Why are sleep logs important?

Utilizing a sleep log is important because sleep is a crucial indicator of mental and physical health. A systematic review from the journal Sleep Science found that sleep disturbances and sleep disorders were associated with harmful disruptions to the HPA axis and metabolism [6]. Furthermore, a randomized clinical trial with 3,755 young adult participants found that an intervention alleviating insomnia also lowered reported symptoms of paranoia and hallucinations [7]. Sleep logs are a common measure in sleep research and tracking progress in sleep therapy. A systematic review of 27 sleep intervention studies found that sleep logs were used in around 80% of studies [8]. Sleep logs can help both therapists and clients grow in awareness of the client’s response to therapeutic interventions. Adhere.ly makes these sleep logs even more accessible.

‍How to use Adhere.ly’s sleep log feature

Adhere.ly is an intuitive tool for monitoring your client’s sleep health. You can send reminders directly to your client with the sleep log attached so they can complete their sleep log right from their device, making adherence easy to achieve. Here is how to set up a sleep log with Adhere.ly [Adhere.ly’s Sleep Log Video Tutorial on YouTube]

 Send your client reminders to complete their sleep log

1. Once you have logged in to your account and selected your client, click “Remind” on the left navigation. Then, scroll down and click on “Sleep Log”.

After selecting the reminder, you will see a preview of what your client will see when they complete the sleep log.

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2. Now choose the dates and times for your client to record their sleep.

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3. Hit confirm and your client will receive a message to complete the sleep log

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Review your client’s sleep log data

1. After the client has entered some data, you can review their responses in the “Review” tab, then click “Sleep Log” at the top of the screen.

2. Here you can see a graph of your client’s sleep efficiency score for the week. Scroll over points on the graph to see the exact score. You can also change the range of time displayed in the top left. 

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3. To see your client’s complete sleep log, click the plus icon and scroll down. Here you can see data like what time your client went to bed and how many times they woke up. You can also view the calculation for the sleep efficiency score, which is the percentage of time your client was asleep while in bed. 

‍Closing

Tracking sleep health with a sleep log is a convenient and effective way to monitor your client’s wellbeing. By incorporating sleep logs into your treatment plan, therapy becomes more holistic as the biological rhythms of your client are taken into consideration. Adhere.ly provides an intuitive digital sleep log to help clients easily complete entries and to help therapists understand the data immediately. Sign-up for Adhere.ly and assign your clients reminders to complete a sleep log today!

[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. Psychiatry Online | DSM Library

[2] Kung PY, Chou KR, Lin KC, Hsu HW, Chung MH. Sleep disturbances in patients with major depressive disorder: incongruence between sleep log and actigraphy. Archives of psychiatric nursing. 2015 Feb 1;29(1):39-42. 1. Sleep Disturbances in Patients With Major Depressive Disorder: Incongruence Between Sleep Log and Actigraphy - ScienceDirect

[3] Lauderdale DS, Chen JH, Kurina LM, Waite LJ, Thisted RA. Sleep duration and health among older adults: associations vary by how sleep is measured. J Epidemiol Community Health. 2016 Apr 1;70(4):361-6. Sleep duration and health among older adults: associations vary by how sleep is measured | Journal of Epidemiology & Community Health (bmj.com)

[4] Short MA, Arora T, Gradisar M, Taheri S, Carskadon MA. How many sleep diary entries are needed to reliably estimate adolescent sleep?. Sleep. 2017 Mar 1;40(3). How Many Sleep Diary Entries Are Needed to Reliably Estimate Adolescent Sleep? | SLEEP | Oxford Academic (oup.com)

[5] Tonetti L, Mingozzi R, Natale V. Comparison between paper and electronic sleep diary. Biological Rhythm Research. 2016 Sep 2;47(5):743-53. Full article: Comparison between paper and electronic sleep diary (tandfonline.com)

[6] Hirotsu C, Tufik S, Andersen ML. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep Science. 2015 Nov 1;8(3):143-52. Interactions between sleep, stress, and metabolism: From physiological to pathological conditions - ScienceDirect

[7] Freeman D, Sheaves B, Goodwin GM, Yu LM, Nickless A, Harrison PJ, Emsley R, Luik AI, Foster RG, Wadekar V, Hinds C. The effects of improving sleep on mental health (OASIS): a randomized controlled trial with mediation analysis. The Lancet Psychiatry. 2017 Oct 1;4(10):749-58. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis - ScienceDirect

[8] Friedrich A, Schlarb AA. Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students. Journal of sleep research. 2018 Feb;27(1):4-22. Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students - Friedrich - 2018 - Journal of Sleep Research - Wiley Online Library