Are Most Americans Getting Enough Sleep?
No. This CDC research brief, a cross-sectional analysis of 2020 Behavioral Risk Factor Surveillance System survey data, found that 33.2% of US adults report sleeping less than 7 hours per 24-hour period. The data reveals stark geographic and demographic patterns, with counties in the highest quintile of short sleep duration clustered in the Southeast and along the Appalachian Mountains.
Dr. Kumar’s Take
Sleep is not optional maintenance for your body and brain. This study shows that insufficient sleep affects one in three American adults, with clear geographic hotspots that demand targeted intervention. If you live in a high-prevalence area or belong to an affected demographic group, prioritize sleep as seriously as you would any other health metric. Seven hours minimum is not a suggestion, it is a biological requirement.
Key Findings
The study analyzed self-reported sleep data from 390,193 adults across the 50 states and the District of Columbia, and found that short sleep duration varies by location and demographics. Counties with the highest model-based prevalence clustered in the Southeast and along the Appalachian Mountains. County-level age-adjusted estimates ranged from 23.8% in Boulder County, Colorado, to 48.4% in Greene County, Alabama.
Demographic disparities were equally striking. Adults aged 25 to 44 years had the highest prevalence by age group, men had a higher prevalence than women, and non-Hispanic Native Hawaiian or Pacific Islander and non-Hispanic Black adults had a higher prevalence than non-Hispanic White, non-Hispanic Asian, and Hispanic adults. Adults who were divorced, widowed, or separated had the highest prevalence by marital status, and those with some college had the highest prevalence by education. Prevalence rose as income fell and as urbanicity decreased.
Brief Summary
This cross-sectional study used 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to examine sleep duration among US adults aged 18 years or older. Sleep information was reported by 390,193 respondents, 98.8% of those surveyed, across the 50 states and the District of Columbia. The primary outcome was self-reported short sleep duration, defined as less than 7 hours per 24-hour period. The authors calculated crude and age-adjusted prevalence estimates, examined variation by sociodemographic and urban-rural characteristics, and modeled county-level prevalence for 3,143 counties.
Study Design
This was a population-based cross-sectional survey using the CDC’s Behavioral Risk Factor Surveillance System, an annual random-digit-dialed landline and cell phone survey of noninstitutionalized adults. National estimates here covered adults aged 18 years or older in the 50 states and the District of Columbia. The median response rate across those jurisdictions was 47.6%, with a range of 34.5% to 67.2%. Participants answered a single question: “On average, how many hours of sleep do you get in a 24-hour period?” Responses under 7 hours were classified as short sleep duration. County-level estimates were produced with multilevel logistic regression and poststratification, and validated against direct survey estimates in the 183 counties with a sample size of 500 or more, where the Pearson correlation coefficient was 0.90.
Results You Can Use
One in three American adults reports insufficient sleep, with the national age-adjusted prevalence at 33.2%. The geographic variation is substantial: model-based age-adjusted county estimates ran from 23.8% in Boulder County, Colorado, to 48.4% in Greene County, Alabama, and the highest-prevalence counties clustered in the Southeast and along the Appalachian Mountains.
Adults aged 25 to 44 years had the highest prevalence of any age group. Income tracked closely with sleep: prevalence rose from 29.3% among adults in households earning $75,000 or more to 38.1% among those earning less than $15,000. Urbanicity mattered too, rising from 32.0% in large central metropolitan counties to 35.0% in noncore counties. These patterns suggest that work schedules, stress levels, and access to sleep-promoting environments vary across American communities.
Why This Matters For Health And Performance
The authors note that short sleep duration is associated with increased risk of chronic conditions including obesity, diabetes, hypertension, heart disease, stroke, anxiety, and depression. The county-level geographic pattern of short sleep duration resembles the patterns for modeled prevalence of diabetes, hypertension, heart disease, stroke, and depression, along with mortality from heart disease and stroke. The authors suggest this similarity may partially reflect geographic patterns of other chronic conditions, for which short sleep duration is a risk factor.
How to Apply These Findings in Daily Life
- Assess your local risk: If you live in the Southeast or Appalachian regions, be extra vigilant about sleep hygiene and duration
- Address environmental factors: Evaluate your bedroom for sleeping conditions, noise, and light exposure, the household and neighborhood factors the authors flag as targets for local sleep health efforts
- Move regularly: The authors point to regular physical activity as a way to establish healthy sleep habits and improve sleep duration
- Consider socioeconomic factors: If you are in an affected demographic group, prioritize sleep despite competing demands from work or caregiving
- Advocate for community changes: Support policies that promote healthy sleep schedules, such as later school start times and limits on shift work hours
- Screen for sleep disorders: Higher-risk populations should get evaluated for sleep apnea and other treatable conditions
Limitations To Keep In Mind
The authors list several limitations. Direct estimates were based on self-reported data and depended on accurate recall. Results may have been influenced by nonresponse bias, which the authors addressed with sampling weights. The COVID-19 pandemic may have affected 2020 BRFSS data collection and influenced the estimates. County-level figures came from multilevel regression and poststratification, which can introduce bias from both the underlying surveys and the modeling approach. Beyond that, the cross-sectional design cannot establish causation between geographic or demographic factors and sleep patterns, and the single survey question captured duration rather than sleep quality or sleep disorders.
Related Studies And Internal Links
Association of Sleep Duration with Incidence of Dementia in Middle and Old Age
Episode 31: Depression Explained, The Biology Behind the Darkness
Episode 32: Depression Recovery Roadmap: A Step-by-Step, Evidence-Based Plan
Exposure to Room Light Before Bedtime Suppresses Melatonin Onset
Associations Between Light Exposure, Sleep Timing, and Sleepiness
Glycine Ingestion Improves Subjective Sleep Quality in Human Volunteers
FAQs
What counts as short sleep duration?
In this study, short sleep duration is less than 7 hours per 24-hour period, applied as a single threshold to all adults aged 18 years or older. The recommended amount is 7 hours or more per night, based on the joint consensus statement of the American Academy of Sleep Medicine and the Sleep Research Society.
Should I be concerned if I live in a high-prevalence area?
Yes, but focus on what you can control. While geographic factors may increase your risk, individual sleep hygiene practices, stress management, and screening for sleep disorders can help you get adequate sleep regardless of location. Talk to your clinician about sleep assessment if you consistently get less than 7 hours.
Why do some regions sleep so much less than others?
The authors point to household and neighborhood factors such as sleeping conditions, safety, noise, and light exposure as targets for investigation, and note that health risk behaviors including cigarette smoking and not meeting physical activity guidelines also increase as urbanicity decreases. Increasing the proportion of adults who get enough sleep is a Healthy People 2030 objective.
Conclusion
Short sleep duration affects one-third of American adults, with clear geographic and demographic patterns that demand targeted public health responses. Whether you live in a high-prevalence region or belong to an affected demographic group, prioritizing 7 or more hours of sleep is one of the most impactful steps you can take for your long-term health and daily performance.
