Sleep and Wind-Down Diary: A Seven-Day Sleep, Energy and Activity Record for Long COVID
Long COVID · Practice-informed · Practice-informed
A seven-day diary of lights out, getting up, hours asleep, sleep quality, energy on waking, the previous day's activity level and symptoms, with a tick list for a gentle wind-down routine and a prompt to look for the client's own pattern. There is no sleep restriction anywhere in it, because the effect of time-in-bed cuts on people with post-exertional symptoms has not been tested. A very small observational study of 14 people found that longer sleep went with less fatigue the next day and that the benefit looked weaker after busier days, which is a reason to record the two side by side and is not proof that a routine changes anything.
Underlying mechanism: Sleep, Energy and Activity Diary with Gentle Wind-Down Routine (No Sleep Restriction) for Long COVID
What it helps with
- Seeing the client's own pattern of sleep, energy and activity, including whether a busy day is followed by a worse night.
- Building a gentle evening routine from a menu the client chooses, such as a regular wind-down hour, dimmer lights, a notepad for worries and a regular time to get up.
- Keeping sleep work safe for clients with post-exertional symptoms by ruling out restriction and curfews.
- Giving the client a sleep rating that can sit alongside the other measures.
How clinicians use it
- Start the diary in Session 4 and keep it for seven days. Rough guesses are fine.
- Look back together at the next session for a pattern after busy days and rest days, and treat the client's own pattern as more important than any general rule.
- Build the wind-down from the ticked ideas and use a notepad for the worrying mind instead of a debate.
- Refer on if sleep is very poor, if the client snores loudly and wakes gasping, or if a sleep disorder is suspected.
Clinical Implementation Guide
- Explain that the diary is for seeing the client's own pattern and that nothing in it restricts sleep.
- Choose the wind-down ideas the client will actually try and agree a regular time to get up.
- Review the week together and refer on if a sleep disorder is suspected.
What the worksheet looks like
| Day | Lights out | Got up | Hours asleep | Sleep quality (1 to 5) | Energy on waking (0 to 10) | Yesterday's activity |
|---|---|---|---|---|---|---|
| Mon | 22:30 | 07:30 | 6.5 | 3 | 4 | Low |
| Tue | 22:45 | 07:30 | 5.5 | 2 | 3 | High |
Clinical cautions
Do not use sleep restriction, time-in-bed cuts, bed-time curfews or lie-in bans, and tell the client never to cut down their time in bed or to force themselves to stay up. Refer on for signs of sleep apnoea or another sleep disorder. Wind-down routines are standard practice and untested in Long COVID, so do not promise that a routine will change fatigue. Keep the diary light if recording becomes a burden. This tool does not diagnose any condition and is not a substitute for individual face-to-face therapy or for emergency crisis support.
References
- Aboagye, N. Y., Baker, M. R., Baker, K., & Del Din, S. (2026). Bidirectional associations between autonomic function, sleep quality, and daily fatigue and energy symptoms in long COVID: Longitudinal digital health study. JMIR Cardio, 10, e99630. https://doi.org/10.2196/99630.
Copyright and use in research
© 2026 Dr Richard Pomfret and Third Wave Therapy Tools. May be used in research with the author and site cited. Version 1.1, approved 21 October 2026, revised as the evidence develops.
Suggested citation (APA 7th edition): Pomfret, R. (2026). Steady Ground: A stepped, measurement-led psychological protocol for adults with Long COVID (Version 1.1) [Therapist guide and worksheets]. Third Wave Therapy Tools. https://thirdwavetherapytools.com/
Part of
Steady Ground
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