Part 7 of 8 in the "how TCM assesses poor sleep" series. The other seven are listed at the foot.

"I sleep badly every night." That sentence is hard to use in a consultation. Seven days of a log turn it into: which three nights, and what was different about them.

The short version

• Four columns are enough: to bed, asleep, woke, up. Plus one line of notes — caffeine, naps, what you did before bed.
• Singapore HealthHub says a sleep record could allow one to calculate total sleep time, identify sleep disruptions and other unknown factors, and would also serve as useful information for healthcare professionals in deciding whether there is a sleep disorder.
• Below is a fictional 7-day log, there to show the reading. The reading takes three steps: the gap in the "asleep" column, then the notes against it, last the "up" column.
• A log is data, not a diagnosis. Which of it matters, and how much, is talked through at the consultation.

First, the things that cannot wait

You snore with pauses in breathing, or wake up gasping; daytime sleepiness is severe enough to affect driving or work safety — see a doctor for investigation first.

Mood is persistently low, anxiety is hard to control, or you have thoughts of harming yourself — this is not something to wait on. Call 999 now, or go to the nearest hospital emergency department. To talk to someone, the Ministry of Health's Talian HEAL 15555 is open every day from 8 am to 12 midnight, public holidays included; Befrienders KL is open 24 hours on 03-7627 2929. You can also contact your doctor.

The full list, and the reason for each, are in part 8. TCM and Western medicine complement each other; it is not a choice between them.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

I. The four columns

Before the consultation, keep a 7-day sleep log. This is what we suggest; four columns are enough:

• To bed — what time you lay down.
• Asleep — roughly when you fell asleep; an estimate is fine.
• Woke — how many times during the night, and roughly for how long.
• Up — what time you got up.

For example: "Monday · to bed 23:30 · asleep about 00:10 · woke 2 times · up 07:00".

Add one line of notes: the time of the day's last kopi or teh, whether you napped, what you did before bed. Those few lines are more complete than recalling it on the spot.

Why those four are enough: Singapore's HealthHub (Ministry of Health), on its Sleeping Well page, says a sleep record could allow one to calculate total sleep time, identify sleep disruptions and other unknown factors that may influence sleep, and that it would also serve as useful information for healthcare professionals in deciding whether there is a sleep disorder. The time you went to bed and woke up, and total sleep hours with perceived quality of sleep, are the first two items on its record list.

Shift work or a long commute: put your real bed and wake times into the 7-day log, shift days and rest days alike; your schedule is part of what the practitioner needs to understand.

II. How to read a log

How to read a log: one illustration. Below is a fictional 7-day log (the numbers are made up), there to show the reading, not anyone's record.

The reading takes three steps:

• First, the gap in the "asleep" column. On Wednesday, Friday and Saturday it took about 75 minutes to fall asleep, with 3 wakings; on the other four nights, 30 to 40 minutes and 1 to 2 wakings. From memory, this week would probably be described as "I sleep badly every night"; the log says which three nights, and what was different about them.
• Then set the notes against it. The three worst nights share three things in the notes: a nap at four or five in the afternoon, a teh tarik from nine, dinner from nine. The 15:00 kopi is there on five of the seven days, good nights included — so the log moves the conversation from "should I give up kopi" to "the cup from nine". HealthHub's advice is to avoid caffeine four to six hours before bedtime: in the illustration the 15:00 cup falls outside that window, the 21:00 cup inside it.
• Last, the "up" column. Saturday is the longest night on paper, and the wake time is three and a half hours later than on weekdays. HealthHub's advice is to get up at the same time every day, weekends included; the Hong Kong Department of Health's Chinese Medicine Regulatory Office sleep guide says to go to bed and get up on time.

The time and length of a nap get asked about too. In the illustration the naps start between four and five in the afternoon and run 45 minutes to 1 hour.

HealthHub's position is to avoid daytime naps; if you must, keep it within 30 to 45 minutes, and not in the evening; the Hong Kong Department of Health's sleep guide speaks of a short nap at the midday hour, 15 minutes to 1 hour.

Which of these matters, and how much, is talked through at the consultation, not settled in this illustration.

That is what a log has that memory does not. HealthHub says a record can identify sleep disruptions and other unknown factors; its example, in the passage on sleep tracking, is that after tracking one may notice certain activities that get in the way of enough sleep, such as binge-watching shows at night.

The words in this part

Three of the four are the HealthHub pages' own terms; one comes from the Hong Kong Department of Health's sleep guide.

• Sleep record (睡眠记录; also sleep diary) — HealthHub's term. It says a record could allow one to calculate total sleep time and identify sleep disruptions and other unknown factors.
• Perceived quality of sleep (自觉的睡眠质量) — one of the items on HealthHub's record list, sitting next to total sleep hours. It is your own assessment, not an instrument reading.
• Sleep tracking (睡眠追踪) — HealthHub's term for measuring sleep duration with a wearable device; the page says it is similar to a sleep diary.
• 子午觉 (zǐ wǔ jiào, the midday and midnight sleep) — the sleeping pattern TCM health preservation favours. The Hong Kong Department of Health's sleep guide says: be asleep at the midnight hour, a short nap at the midday hour is also fine, and 15 minutes to 1 hour is considered suitable.

Frequently asked

Are estimated times all right? Yes. The "asleep" column says in terms that an estimate is fine. The point is not minute-accuracy; it is which nights were different — which is exactly the gap the reading in section II uses.

Does it have to be seven days? Seven is the length we suggest, because it takes in both working days and the weekend — which is how Saturday's row shows up in the illustration above. HealthHub puts the threshold this way: if a sleep problem has persisted for at least a month, caused significant distress and interfered with social or work life, one could consider keeping a sleep record.

Do not: draw conclusions about yourself from this illustration — its numbers are made up, and its only use is to show the reading.

The other seven parts

• Part 1: What inquiry is, how it works online, what one consultation produces
• Part 2: What TCM theory holds sleep to be
• Part 3: Why appetite, palpitations and mood get asked about
• Part 4: What is asked about the sleep itself and the daytime
• Part 5: Why mood, stress and your current medication are asked about
• Part 6: Poor sleep: what is usually done
• Part 8: When to see a doctor first

👉 If you are not sure where to begin with your own poor sleep, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you; if anything in "First, the things that cannot wait" above or in part 8 applies, see a doctor first.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

Sources

• Chinese Medicine Regulatory Office, Department of Health, Hong Kong, 〈中医养生－睡眠篇〉 (PDF, 3 pp.) — https://www.cmro.gov.hk/files/gb/useful_information/public_health/feature_articles/TCM_019.pdf
• Singapore HealthHub (MOH), 11 Healthy Habits to Sleep Better, article last reviewed 21 December 2021 — https://www.healthhub.sg/well-being-and-lifestyle/mental-wellness/overcoming_insomnia
• Singapore HealthHub (MOH), MindSG — Sleeping Well (Adults), no review date shown on the page — https://www.healthhub.sg/programmes/mindsg/caring-for-ourselves/sleeping-well-adults
• Ministry of Health Malaysia, Hospital Pendang (Kedah State Health Department), Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur — https://www.befrienders.org.my/

本文是「睡不好，中医会怎么评估」系列的第 7 篇，共 8 篇。其余七篇列在文末。

「我每晚都睡不好。」这句话在问诊里很难用。一份 7 天的记录会把它换成：哪三晚，以及那三晚有什么不同。

一分钟看完

• 四栏就够：上床、入睡、醒几次、起床。另加一行备注：咖啡因、午睡、睡前在做什么。
• 新加坡卫生部 HealthHub 说，睡眠记录可以算出总睡眠时间、找出干扰睡眠的情况与其他未知的因素，也能为医疗人员判断是否有睡眠障碍提供有用的资料。
• 下面有一份虚构的 7 天记录，用来说明读法。读法分三步：先看「入睡」那一栏的差距，再对照备注，最后看「起床」。
• 记录是资料，不是诊断。哪一样有关系、有多大关系，是看诊时谈的事。

先说不能等的几件事

睡觉时打鼾伴随呼吸暂停、或被憋醒；白天严重嗜睡，影响驾驶或工作安全——请先就医做检查。

情绪持续低落、焦虑难以控制，或出现伤害自己的念头——这不是可以等的事。请立刻拨打 999，或前往最近的医院急诊部。若想找人谈一谈，卫生部的 Talian HEAL 15555 每天早上 8 时至午夜 12 时开放，包括公共假期；Befrienders KL 24 小时热线：03-7627 2929。您也可以联络您的医生。

完整清单与每一项的理由，见第 8 篇。中医与西医是互相补位的关系，不是二选一。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、四栏怎么记

看诊前，先记 7 天睡眠记录。 这是我们建议的做法，四栏就够：

• 上床：几点躺下。
• 入睡：大约几点睡着，估计就好。
• 醒几次：中间醒来几次、大约多久。
• 起床：几点起来。

例如：「星期一 · 上床 23:30 · 入睡约 00:10 · 醒 2 次 · 起床 07:00」。

另加一行备注：当天最后一杯 kopi 或 teh 的时间、有没有午睡、睡前在做什么。这几行字，比事后回忆来得完整。

这四栏为什么够用：新加坡卫生部 HealthHub 的「睡好觉」页面说，睡眠记录可以算出总睡眠时间、找出干扰睡眠的情况与其他未知的因素，也能为医疗人员判断是否有睡眠障碍提供有用的资料。上床与起床时间、总睡眠时数与自觉的睡眠质量，是它记录清单的头两项。

轮班工作或长时间通勤：把实际的上床与起床时间记进 7 天记录，轮班日和休息日都记；作息本身就是医师要了解的一部分。

二、怎么读一份记录

怎么读一份记录：一个示例。 下面是一份虚构的 7 天记录（数字是编的），用来说明「读法」，不是任何人的记录。

读法分三步：

• 先看「入睡」那一栏的差距。 星期三、五、六这三晚，从上床到入睡都花了约 75 分钟，夜里醒 3 次；其余四晚是 30 到 40 分钟，醒 1 到 2 次。凭记忆，这一周多半会被说成「每晚都睡不好」；记录说的是：哪三晚，以及那三晚有什么不同。
• 再对照备注。 最差的三晚，备注有三样共同点：下午四五点的午睡、晚上九点起的 teh tarik、九点起的晚餐。下午三点的 kopi 七天里有五天都有，好的夜里也有——所以记录把话题从「要不要戒 kopi」移到「九点起的那一杯」。HealthHub 的建议是睡前四至六小时避免咖啡因：示例里下午三点那杯在这个窗口之外，晚上九点那杯在窗口之内。
• 最后看「起床」。 星期六在纸上是最长的一夜，起床时间却比平日晚了三个半小时。HealthHub 的建议是每天同一时间起床，周末也一样；香港卫生署中医药规管办公室的〈中医养生－睡眠篇〉说应按时就寝和起床。

午睡的时间与长度也会被问到。示例里的午睡在下午四点到五点之间开始、45 分钟到 1 小时。

HealthHub 的立场是白天尽量不午睡；若一定要睡，控制在 30 至 45 分钟内，且不要在傍晚睡；香港卫生署的睡眠篇说的是午时小睡、15 分钟至 1 小时。

这几样哪一个有关系、有多大关系，是看诊时谈的事，不在这份示例里。

这就是记录比记忆多出来的东西。HealthHub 说，记录可以找出干扰睡眠的情况与其他未知的因素；它谈睡眠追踪时举的例子是：追踪之后可能发现某些让自己睡不够的活动，例如晚上追剧。

这篇出现的几个词

四个词里，三个是 HealthHub 页面上的用语，一个来自香港卫生署的睡眠篇。

• 睡眠记录（sleep record / sleep diary）——HealthHub 的用词。它说记录可以算出总睡眠时间、找出干扰睡眠的情况与其他未知的因素。
• 自觉的睡眠质量（perceived quality of sleep）——HealthHub 记录清单上的项目之一，和「总睡眠时数」并列。它是您自己的评价，不是仪器读数。
• 睡眠追踪（sleep tracking）——HealthHub 用来指用穿戴设备记录睡眠时数的做法，它说这与睡眠日记相似。
• 子午觉（zǐ wǔ jiào）——中医养生主张的睡法。香港卫生署的睡眠篇说：夜半子时应在睡梦中，中午午时也可小睡一会儿，午睡以 15 分钟至 1 小时为宜。（子时是传统十二时辰的夜半时段，午时是正午时段。）

常见问题

估计的时间可以吗？ 可以。「入睡」那一栏本来就写「估计就好」。重点不是分钟数精确，而是哪几晚不一样——上面第二节的读法用的就是这个差距。

一定要七天吗？ 七天是我们建议的长度，因为它同时包含工作日和周末，上面示例里星期六那一行就是这样露出来的。HealthHub 的说法是：睡眠问题持续至少一个月、造成明显困扰并影响社交或工作时，可以考虑记睡眠记录。

不要这样做： 不要照着这份示例给自己下结论——它的数字是编的，用途只是说明读法。

这个系列的另外七篇

• 第 1 篇：问诊是什么、线上怎么看，一次问诊会得到什么
• 第 2 篇：中医理论怎么理解「睡」
• 第 3 篇：为什么问食欲、心悸和情绪
• 第 4 篇：问睡眠本身与白天，是在问什么
• 第 5 篇：为什么问情绪、压力和我在吃的药
• 第 6 篇：睡不好，一般怎么做
• 第 8 篇：什么时候要先看西医

👉 如果您不确定「我这种睡不好，该从哪里谈起」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若您有本文「先说不能等的几件事」与第 8 篇列出的情况，请先看医生。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 香港卫生署中医药规管办公室〈中医养生－睡眠篇〉（PDF，3 页） — https://www.cmro.gov.hk/files/gb/useful_information/public_health/feature_articles/TCM_019.pdf
• 新加坡卫生部 HealthHub，11 Healthy Habits to Sleep Better，页面最后审阅 2021 年 12 月 21 日 — https://www.healthhub.sg/well-being-and-lifestyle/mental-wellness/overcoming_insomnia
• 新加坡卫生部 HealthHub，MindSG — Sleeping Well (Adults)，页面未标示审阅日期 — https://www.healthhub.sg/programmes/mindsg/caring-for-ourselves/sleeping-well-adults
• 马来西亚卫生部，Hospital Pendang（吉打州卫生局）Info Kesihatan 2024 — https://jknkedah.moh.gov.my/hpendang/index.php?option=com_sppagebuilder&view=page&id=139
• Befrienders Kuala Lumpur — https://www.befrienders.org.my/