Paediatric Neurologist Template

Sleep History

A professional Paediatric Neurologist template for healthcare professionals.

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Specialty

Paediatric Neurologist

Used

63 times

Type

Note

Last edited

1/16/2025

Created by

Audrey Brumback

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About this template

The Sleep History template is an essential tool for paediatric neurologists to comprehensively document a child's sleep patterns and related factors. This template covers various aspects such as sleep schedule, environment, hygiene, onset, maintenance, quality, and behaviours. It also includes sections for previous sleep studies, medications, medical history, family history, and social history. By using this template, clinicians can gain a holistic view of a child's sleep health, aiding in the diagnosis and management of sleep disorders. This template is particularly useful for identifying issues like insomnia, sleep apnea, and other sleep-related conditions in children.

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SLEEP SCHEDULE: - Typical bedtime: 8:30 PM - Typical wake time: 6:30 AM - Naps (frequency, duration, timing): Occasionally, 30 minutes in the afternoon - Variability in sleep schedule: Consistent on weekdays, later bedtime on weekends SLEEP ENVIRONMENT: - Bedroom setup (bed, pillows, blankets): Comfortable bed with two pillows and a light blanket - Noise level: Quiet - Light exposure: Blackout curtains used - Temperature: Cool, around 20°C - Electronics in bedroom: No electronics allowed SLEEP HYGIENE: - Pre-bedtime routine: Reading a book for 30 minutes - Caffeine intake (amount, timing): No caffeine intake - Alcohol intake (amount, timing): Not applicable - Exercise (type, duration, timing): Plays soccer for 1 hour in the afternoon - Screen time before bed: Limited to 15 minutes SLEEP ONSET: - Time to fall asleep: 15 minutes - Difficulty falling asleep: Occasionally - Thoughts or worries when trying to sleep: None reported - Restlessness or discomfort: None SLEEP MAINTENANCE: - Number of awakenings per night: 1-2 times - Duration of awakenings: 5-10 minutes - Ability to fall back asleep: Easily - Reasons for awakenings: Occasionally needs to use the bathroom SLEEP QUALITY: - Feeling rested upon awakening: Usually - Daytime sleepiness or fatigue: Rarely - Concentration or memory difficulties: None - Mood disturbances: None SLEEP BEHAVIORS: - Snoring: None - Gasping or choking: None - Witnessed apneas: None - Restless legs or periodic limb movements: None - Sleep talking or sleepwalking: None - Nightmares or night terrors: Occasionally - Sleep paralysis: None - Teeth grinding (bruxism): None PREVIOUS SLEEP STUDIES: - Type of study (e.g. polysomnogram, MSLT): Not applicable - Date and location: Not applicable - Results and diagnosis: Not applicable MEDICATIONS: - Current medications for sleep: None - Past medications tried for sleep: None - Other medications that may impact sleep: None MEDICAL HISTORY: - Conditions that may impact sleep (e.g. chronic pain, GERD, asthma): Asthma - Psychiatric history (e.g. anxiety, depression): None - Neurologic history (e.g. restless legs syndrome, narcolepsy): None FAMILY HISTORY: - Family members with sleep disorders: Father has sleep apnea - Family members with psychiatric or neurologic conditions: None SOCIAL HISTORY: - Work schedule (shift work, irregular hours): Not applicable - Living situation and bed partner: Lives with parents, no bed partner - Travel and jet lag: None recently OTHER NOTES: - None