Many people notice their sleep changing in midlife. You may wake at 3 a.m. and lie there thinking about work, money or family. You may fall asleep fine but wake up too early. Or you may simply never feel rested.
Midlife is when short sleep is most common. Stress, hormones, health problems and habits all play a part. The good news is that insomnia is very treatable, and the best-tested treatment does not need a pill.
Key points
- In 2024, about 1 in 3 US adults aged 50 to 64 (35%) slept less than 7 hours a night, the highest of any age group.1
- About 1 in 5 people aged 50 to 64 (22%) had trouble staying asleep most days.1
- Insomnia and depression feed each other. People with insomnia had about twice the risk of later depression in a large review.6
- CBT for insomnia (CBT-I) is the first treatment recommended by major medical groups.2,3 Strong evidence
- Loud snoring or gasping at night can be sleep apnea, a different problem that needs its own treatment.5
How common sleep problems are in midlife
A 2024 national US survey found:1
| Age group | Slept less than 7 hours | Trouble staying asleep most days |
|---|---|---|
| 35 to 49 | 33% | 17% |
| 50 to 64 | 35% | 22% |
| 65 and older | 27% | 22% |
Women had more trouble than men. About 21% of women had trouble staying asleep most days, compared with about 15% of men. About 19% of women had trouble falling asleep, compared with 12% of men.1
Signs of insomnia
Insomnia means trouble falling asleep, staying asleep or waking too early, even when you have time and a good place to sleep. It also affects your days. Doctors call it chronic (long-term) insomnia when it happens at least 3 nights a week for at least 3 months and causes distress or problems in daily life.2
Common signs:
- Lying awake for a long time before sleep
- Waking often, or waking very early and not getting back to sleep
- Feeling tired, foggy or irritable during the day
- Worrying about sleep as bedtime gets closer
Take the free insomnia test to see how much your sleep is affecting you. For background, read our page on insomnia.
Why sleep gets harder in midlife
The National Heart, Lung, and Blood Institute lists these risk factors for insomnia:4
- Age. The chance of insomnia rises as you get older.
- Hormones. Insomnia is more common in women. Menopause can disturb sleep.
- Stress. Worries about work, money, relationships or a loved one's illness or death.
- Caffeine, alcohol and nicotine.
- Shift work and travel across time zones.
- Habits. Irregular schedules, long naps, little activity and screens before bed.
Menopause. Hot flashes and night sweats often wake women during perimenopause and menopause.9 See our guide on menopause and mental health.
Sleep apnea. Breathing stops and starts during sleep. Risk rises with age and weight, and it is more common in men. Alcohol can make it worse by relaxing throat muscles.5 See sleep apnea.
Life load. Caregiving, job stress and pain all keep the mind busy at night. See caregiving, work and chronic pain and mood.
How poor sleep affects mood and health
Poor sleep and low mood tend to feed each other. A review of 34 studies, with more than 170,000 people, found that people with insomnia were about twice as likely to develop depression later. The link was smaller after adjusting for gaps in the research, but it was still there.6
Women with long-term insomnia also have higher rates of mood disorders and other health problems.9 Read more in sleep, mood and anxiety.
What helps
CBT for insomnia (CBT-I)
Strong evidenceCBT-I is a short, structured program. It combines sleep education, changing unhelpful thoughts about sleep, and behavior steps such as a set sleep window and getting out of bed when you cannot sleep. The American Academy of Sleep Medicine gives it a strong recommendation.3 The American College of Physicians recommends it as the first treatment for chronic insomnia in adults.2 It works in person, by phone, online or with a self-help book.2 Start with our free CBT-I lessons.
CBT-I for menopause-related insomnia
Moderate evidenceIn a trial of 106 women aged 40 to 65 with hot flashes, CBT-I by phone improved insomnia much more than menopause education did.8
Single CBT-I parts
Moderate evidenceStimulus control, sleep restriction and relaxation therapy each have conditional support when used alone.3 Try muscle relaxation or a body scan at bedtime.
Sleep hygiene tips alone
Limited researchTips like avoiding caffeine and keeping the room dark are useful, but they are not enough to treat chronic insomnia on their own.3
Sleep medicines
Moderate evidence · short-termIf CBT-I alone does not work, you and your doctor can decide together whether to add a medicine. Prescription sleep pills are mainly meant for short-term use.2 Some, such as zolpidem (Ambien), eszopiclone (Lunesta) and zaleplon (Sonata), carry a boxed warning about rare but serious "complex sleep behaviors" like sleepwalking or driving while not fully awake.7 See sleep medications. Talk with your doctor before starting, stopping or changing any medicine.
How CBT-I works, in plain words
CBT-I is not about trying harder to sleep. It works by rebuilding your body's natural drive to sleep and by breaking the link between your bed and being awake.3
- A set sleep window. For a short time, you spend only about as many hours in bed as you are actually sleeping. This builds sleep pressure, so sleep becomes deeper and steadier. Then the window grows step by step. See CBT-I lesson 2.
- Bed is for sleep. Getting up when you cannot sleep teaches your brain that bed means sleep, not worry.
- Calmer thoughts about sleep. Thoughts like "If I don't sleep, tomorrow will be a disaster" keep you alert. CBT-I helps you test and soften them. See CBT-I lesson 4.
A sleep window is best planned with a clinician if you have bipolar disorder, seizures, or a job where sleepiness is dangerous, such as driving for work.
Steps to try for the next two weeks
- Keep a sleep diary. Write down when you go to bed, fall asleep, wake up and get up. The sleep diary makes this easy. See CBT-I lesson 1.
- Pick one wake-up time and keep it every day, weekends too. This is the anchor for your body clock.
- Use the bed only for sleep and sex. If you are awake and frustrated for a long time, get up and do something calm in dim light. Go back when sleepy. See CBT-I lesson 3.
- Cut back on caffeine after noon and on alcohol in the evening. Both can disturb sleep.4
- Build a wind-down hour. Dim lights, put work away, and try slow breathing such as the cyclic sigh. See CBT-I lesson 5.
- Write down worries earlier in the evening, with one next step for each. This keeps them from showing up at 3 a.m.
- Get outside in daylight and move during the day. Avoid long naps.4
For partners and family
- If your partner snores loudly, gasps or stops breathing during sleep, encourage a doctor visit. These can be signs of sleep apnea.5
- Support a steady schedule, even on weekends.
- If poor sleep comes with low mood, irritability or heavy drinking, gently suggest a check for depression. See men's midlife mental health.
- Be patient during CBT-I. It is a skill that takes practice, and a partner's support helps.
Special situations
Shift workers. Night and rotating shifts disturb the body clock.4 Keep your sleep time as steady as you can, and use blackout curtains.
Caregivers. Being woken at night by a loved one is common. Respite care can give you nights of full sleep. See respite care.
Wearable sleep trackers. These can show patterns but are not medical tests. See sleep trackers.
Common questions
How much sleep do I need?
National health surveys count less than 7 hours a night as short sleep.1 How rested you feel during the day is a good guide to whether you are getting enough.
Is it normal to wake up at night in midlife?
Brief waking is normal at any age. But trouble staying asleep most days is common from age 50 to 64, affecting about 1 in 5 adults.1 If it affects your days, it is worth treating.
Do sleep pills work better than CBT-I?
Studies have not compared them directly enough to say. But CBT-I is likely to cause fewer harms, and sleep pills are mainly meant for short-term use. That is why CBT-I is recommended first.2
Will a nightcap help me sleep?
When to get help
See a doctor if:
- Poor sleep lasts more than a few weeks and affects your day
- You snore loudly, gasp, or someone sees you stop breathing in sleep
- You feel very sleepy while driving
- You have low mood, hopelessness or loss of interest for 2 weeks or more
- You are using alcohol or pills to sleep most nights
Your doctor may check for causes such as depression, pain, prostate problems, sleep apnea or restless legs.2
If you have thoughts of suicide, call or text 988 any time. If someone is in immediate danger, call 911.
Sources
- Ng AE, Black LI, Adjaye-Gbewonyo D. Short sleep duration and sleep difficulties among adults: United States, 2024. NCHS Data Brief No. 559, 2026. CDC
- American College of Physicians. ACP recommends cognitive behavioral therapy as initial treatment for chronic insomnia (Qaseem A, et al. Ann Intern Med, 2016). ACP, 2016. ACP
- American Academy of Sleep Medicine. New guideline supports behavioral and psychological treatments for insomnia (Edinger JD, et al. J Clin Sleep Med, 2021). AASM, 2020. AASM
- National Heart, Lung, and Blood Institute. Insomnia: causes and risk factors. NIH, accessed 2026. NHLBI
- National Heart, Lung, and Blood Institute. Sleep apnea: causes and risk factors. NIH, accessed 2026. NHLBI
- Li L, Wu C, Gan Y, Qu X, Lu Z. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC Psychiatry, 2016. BMC Psychiatry
- U.S. Food and Drug Administration. Certain prescription insomnia medicines: new boxed warning due to risk of serious injuries caused by complex sleep behaviors. FDA, 2019. FDA
- McCurry SM, Sternfeld B, LaCroix AZ, et al. Telephone-based cognitive behavioral therapy for insomnia in perimenopausal and postmenopausal women with vasomotor symptoms: a MsFLASH randomized clinical trial. JAMA Intern Med, 2016. Kaiser Permanente Division of Research
- NIH Office of Research on Women's Health. Insomnia. NIH, accessed 2026. NIH ORWH
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.