Why canʼt I get a good night of sleep anymore? Nearly half of all US women over the age of 40 report problems sleeping. In fact, women in midlife report problems sleeping as often as they do with weight gain. Midlife and menopausal women sleep less, report insomnia, and seek help more often than premenopausal women. An important goal is to distinguish if the sleep problem is due to a symptom of menopause or a primary sleep disorder that does not involve menopause symptoms . While menopause does not cause sleeping problems, symptoms of menopause certainly do! Hot flashes occur more often at night and result in disrupted sleep/problems getting back to sleep. Anxiety is another common symptom of menopause that adversely effects sleep. Midlife aged women are often in the “sandwich generation” - caring for aging parents and children, job related sleep development of chronic illness - all sources of stress /anxiety /depression. A common result of these mental health concerns as well as many common chronic medical conditions like diabetes, urinary incontinence or overactive bladder, thyroid problems, fibromyalgia, arthritis , medication side effects, restless leg syndrome IS insomnia. Sleep apnea is commonly diagnosed in midlife and results in poor sleep quality and daytime results. Screening for sleep apnea is so critical because of the association with hypertension and heart disease. The diagnosis of sleep apnea is made through work up such as a sleep study. So….  what can be done for sleep problems ? The short answer is it depends on the personʼs circumstances - what is the patientʼs history, medications etc. Reviewing a sleep diary is very helpful. Treating hot flashes for some is all that is needed. If mood swings, depression or anxiety are part of the history- vitamin B or magnesium helps some as does other prescription medications. Cognitive behavioral therapy (CBT) with a mental health specialist complemented with on-line apps like CBT-i, Breathe or Calm is very effective. Nonprescription and prescription remedies exist but are not part of a good longterm care plan. If one increasingly relies on medicines such as Tylenol Pm or Rozarem to get a good nights sleep, a visit with your health care provider is needed.