What causes poor sleep in adults?
Poor sleep reflects perimenopause, low testosterone, untreated sleep apnea, elevated cortisol, alcohol, blue light, or anxiety. Hormonal causes are common and often missed.
Full answer
Poor sleep in adults has hormonal, behavioral, and environmental drivers. The provider-reviewed differential covers perimenopause/menopause (estrogen and progesterone decline), low testosterone (men), untreated sleep apnea (the single most underdiagnosed cause), elevated evening cortisol, alcohol use, evening blue light, anxiety, and chronic pain. Workup may include estradiol/progesterone, total and free testosterone, AM cortisol with diurnal context, TSH, and sleep study referral. Hormonal optimization improves sleep architecture in many patients but does not substitute for treating apnea or behavioral drivers.
Educational. Not a substitute for individualized provider review.
- Fatigue & recovery — Primary source · oMeds
- Reviewed by Dr. Laura Purdy, MD, MBA · Clinical Director, oMeds · Last reviewed 2026-05-29