You may have been a pretty good sleeper until you went through a hard time and had several nights of bad sleep. Sometimes a few nights turn into months or even years of exhaustion.

Sleep changes a lot over the life span, and hormonal changes do affect sleep. Progesterone has a relaxing effect, and decreasing levels, as occur postpartum and in menopause, are often associated with poor sleep, anxiety, and brain fog. This affects men, too; progesterone is a precurser for testosterone.

Do you fall asleep frequently during the day, and at inappropriate times? Apnea is a medical condition where you periodically stop breathing during the night, jolting awake when your breathing kicks back in. It often occurs in heavy snorers, men middle-aged and older, and with weight gain, although you can suffer from apnea and have none of the above conditions.

Sleep disturbances occur so often in depression that some experts believe it shouldn’t be diagnosed in the absence of sleep problems. It’s hard to benefit from therapy as much as you would like if you’re struggling to keep your eyes open or you can’t get things done because you’re unable to concentrate. In addition to being a symptom of depression, sleep deprivation can also be a cause of depression.

Your sleep problems may have begun with a medical condition or physical pain. You may feel that you need a medical treatment and not psychotherapy. But even in these cases, the work-arounds you’ve done to get more sleep may be inadvertently contributing to ongoing sleep deprivation.

Do you find yourself so revved up that it’s hard to turn off all the thinking thinking thinking when you lie down to sleep? Or perhaps you wake up so many times during the night that you’re unsure you’ve been asleep at all? Momentary awakenings may turn into long blocks of sleeplessness that fragment your night.