Sleep
Sleep diary and sleep efficiency
Log each night you spend in bed, see what share of that time you were asleep, and print the record for a GP.
You have been waking for weeks, and by your appointment you cannot say how much of each night you were actually asleep.
NICE Clinical Knowledge Summaries say a sleep diary kept for 1 to 2 weeks can help identify sleeping patterns and lifestyle factors that worsen insomnia. Sleep efficiency is the percentage of time in bed spent asleep. NICE scoping on digital CBT-I describes that ratio as the figure clinicians watch before the time allowed in bed is gradually extended. The insomnia guide sets out how HRT, menopause-specific CBT and CBT-I fit together.
Take the printout to the appointment. The percentage is an estimate for that conversation. Diagnosis and any change in treatment happen there.
What to write down each night
The assessment page asks you to keep the diary for 2 weeks. Write when you got into bed and when you got up for the day, how many minutes it took to fall asleep, and how many minutes you were awake during the night. It also asks about daytime tiredness, naps, meals, alcohol, caffeine, exercise or stress, and a rating of how you slept.
The span from getting in until the final getting up is the one to use. An East London NHS Foundation Trust CBT-I handout says that span should not be shortened for time spent out of bed before you get up for the day. A bathroom trip stays inside that span. Enter how long you were awake as its own number.
The National Institute on Aging suggests noting caffeine, alcohol and exercise with those clock times, so you and a doctor can see a pattern. The form has optional ticks for those, a yes or no if heat or sweat woke you, a place for the daytime notes, and a rating of sleep quality from 1 to 5. CKS asks for a nightly rating and does not fix the numbers on the scale. Those fields are what a CBT-I sleep diary collects. Counts of each flush, and what you suspect set one off, belong in the hot flush and night sweat diary.
Watches in reader discussions often show a long list of wake-ups, or a stretch awake before dawn, and a device can miss quiet waking if you barely move. Enter the minutes you remember. Those are the ones this sum uses.
Sleep efficiency: one night, then the week
The East London handout and a Nottinghamshire Healthcare booklet both turn the ratio into arithmetic: divide time asleep by the minutes between bed and rising, then multiply by 100. The handout also writes it as average time asleep divided by average time in bed, times 100, over seven nights.
For a single night, start with the minutes between getting in and getting up for the day. Subtract the minutes it took to fall asleep, then subtract the minutes awake later. Divide what remains by the first total and multiply by 100.
Take a night in bed at 23:00 and up at 07:00. The gap is 8 hours, 480 minutes. Falling asleep took 40 minutes, and later waking added 50. Time asleep is 480 minus 40 minus 50, so 390 minutes. Divide 390 by 480 and multiply by 100. That is 81.25, which rounds to 81 percent.
Across several nights, add every minute asleep, add every minute between bed and rising, divide the first total by the second, and multiply by 100. That is the same figure as dividing the two averages.
The handout calls 80 to 85 percent a desirable sleep efficiency when a sleep window is being adjusted in CBT-I, and it describes that range as average. The Nottinghamshire booklet says people with insomnia generally average below 85 percent. A clinician delivering CBT-I is the person who changes how long you stay in bed. The calculator stops at the percentage.
How this differs from the other sheets
The menopause symptom checklist for your GP gathers which symptoms you have, how often they come, and how much they bother you.
Episode by episode, the hot flush diary records hot flushes and night sweats, plus a suspected trigger. Night sweats in menopause explains those episodes, including when drenching sweats need a GP for reasons other than menopause.
People who want a menopause sleep tracker can log clock times and the efficiency figure before an insomnia appointment. If the sweats are what you most need on paper, use the hot flush and night sweat diary. If sleep is still poor after the sweats ease, insomnia in menopause explains how CBT-I is used.
HRT, CBT-I and the appointment
Where chronic insomnia is diagnosed, NICE CKS says to offer cognitive behavioural therapy for insomnia as the first-line treatment for adults of any age. The digital CBT-I scope says that for long-term insomnia, CBT-I is the recommended first-line treatment. The National Institute on Aging also says CBT-I has been shown to improve sleep in women with menopausal symptoms.
Insomnia in menopause also covers menopause-specific CBT for night waking that comes with sweats, including use alongside HRT. The hot flash relief finder lists which flush treatments have trial evidence. Natural alternatives to HRT explains menopause-specific CBT and products sold as natural hormones.
Print the summary and take it to a GP or a sleep clinic. The sleep topic lists the other guides about sleep.
Log your nights
Add one night at a time. Fourteen fit. The latest efficiency appears as soon as a night is saved. Once seven are in, you see average minutes asleep, average minutes between getting into bed and getting up, and efficiency across every night saved.
My take
I would start by logging 14 nights before the appointment, and I would skip shortening the hours in bed based on the percentage alone. I would judge the printout by the clock times and by which nights heat woke me, and I would bring the episode notes too when sweats are what the GP needs to see.
Sources
- NICE Clinical Knowledge Summaries: insomnia
- NICE Clinical Knowledge Summaries: assessment
- NICE Clinical Knowledge Summaries: managing insomnia
- NICE: digital CBT-I final scope
- East London NHS Foundation Trust: CBT for insomnia
- Nottinghamshire Healthcare: sleep efficiency booklet
- National Institute on Aging: sleep and older adults
- How we research and source health guides