Sleep disturbances affect nearly half of women undergoing menopause. Hormonal changes, vasomotor symptoms, medical and psychiatric comorbidities, and the aging process all contribute to the development of sleep disorders, including insomnia, obstructive sleep apnea, and restless legs syndrome. Additionally, the menopausal transition is also associated with cognitive decline. Clinicians must assess perimenopausal women for symptoms such as difficulty in initiating or maintaining sleep, snoring, daytime sleepiness, and cognitive challenges. Effective diagnosis and management of sleep disorders during menopause requires close collaboration between the gynecologist and the sleep physician. Diagnostic tools include sleep diaries, actigraphy, and polysomnography. Many nonpharmacological and pharmacological therapies are available for insomnia, OSA, and RLS, and many other therapies are in development. Lifestyle measures, including adequate diet, exercise, sleep hygiene, and stress reduction, remain the cornerstone for preventing cognitive decline during the menopausal period.