Original resource
Sleep breathing symptom log (14 nights)
Most snoring and mouth-breathing articles tell you what to notice. This sheet helps you keep the notices. It is a simple home record you can bring to a visit or use to see whether a change (allergy care, side sleeping, less alcohol) actually moved the pattern. It does not diagnose anything.
Use your browser’s print dialog. Choose “Save as PDF” if you want a file.
How to use it
- Pick a start date and fill in the “Day” column (for example Mon, Tue) or the calendar date—whatever you will actually keep up with.
- Fill it in once each morning, before the details blur. Sixty seconds is enough.
- Nose: C = clear enough to breathe comfortably through the nose at bedtime; P = partly blocked; B = blocked enough that you knew you would rely on mouth breathing.
- Position: note the position you mostly slept in (side left L, side right R, back B, mixed M).
- Alcohol / sedative: Y if you had alcohol within about three hours of bed, or a sedating cold medicine, sleep aid, or other sedating drug your clinician would want to know about.
- Snoring: compared with your usual: write − if softer, same if unchanged, + if louder, or N if you do not know (no bed partner, no recording).
- Gasp / pause: Y if you woke gasping, choking, or someone saw you stop breathing; N if none of that; ? if unsure.
- Mouth: Y if you woke with dry mouth, sticky mouth, or sore throat you link to open-mouth sleep.
- Morning: a quick 1–4 score for how rested you felt (1 = exhausted, 4 = sharp).
Week 1
Dates: _____________ through _____________
| Day / date | Nose C / P / B |
Position L / R / B / M |
Alcohol or sedative Y / N |
Snoring − / same / + / N |
Gasp / pause Y / N / ? |
Dry mouth Y / N |
Rested 1–4 |
Notes |
|---|---|---|---|---|---|---|---|---|
Week 2
| Day / date | Nose C / P / B |
Position L / R / B / M |
Alcohol or sedative Y / N |
Snoring − / same / + / N |
Gasp / pause Y / N / ? |
Dry mouth Y / N |
Rested 1–4 |
Notes |
|---|---|---|---|---|---|---|---|---|
If you bring this to an appointment
Clinicians can work faster when they see patterns, not a vague “I snore sometimes.” Consider also listing current medications, allergies, and whether anyone has seen you stop breathing.
- How many nights per week the nose felt blocked at bedtime
- Whether snoring is new or years old, and whether it changed after weight gain, pregnancy, or illness
- Any drowsy driving, morning headaches, or blood-pressure issues your team should know about
This log is educational and is not medical advice. If you have choking, gasping, witnessed pauses, or sleepiness that feels unsafe, prioritize medical evaluation over paperwork.