Sleep More Not Less


To promote optimal health and well-being, adults aged 18–60 years are recommended to sleep at least 7 hours each night. Sleeping less than 7 hours per night is associated with increased risk for obesity, diabetes, high blood pressure, coronary heart disease, stroke, frequent mental distress, and all-cause mortality. Insufficient sleep impairs cognitive performance, which can increase the likelihood of motor vehicle and other transportation accidents, industrial accidents, medical errors, and loss of work productivity that could affect the wider community.

This is the first published report to document state-based estimates of self-reported healthy sleep duration for all 50 states and the District of Columbia. On average, 65.2% of adult respondents reported a healthy sleep duration. The geographic distribution pattern of low healthy sleep duration prevalence is consistent with state prevalence patterns of perceived insufficient rest or sleep among U.S. adults. The lower healthy sleep duration prevalence in the BRFSS among non-Hispanic black adults relative to non-Hispanic whites is consistent with a previous nationwide comparison from the National Health and Nutrition Examination Survey. The results also suggest that employment and higher education might be determinants of healthy sleep.

A lower prevalence of healthy sleep duration was observed in the southeastern United States and in states along the Appalachian Mountains. This distribution is similar to geographic variations in prevalence estimates for obesity and diabetes and death rates from heart disease and stroke. Short sleep duration 7 hours per night and other indicators of poor sleep health are associated with greater insulin resistance, metabolic abnormalities, and weight gain, which might then result in diabetes and adverse cardiovascular outcomes. A sleep duration of more than 7 hours is associated with lower prevalence estimates of cigarette smoking, leisure-time physical inactivity, and obesity compared with a short sleep duration. Although unhealthy adults with chronic conditions might sleep longer, little empirical evidence exists to indicate that long sleep duration causes adverse conditions among healthy adults exists.

Based on recent recommendations for healthy sleep duration, these findings suggest that, although almost two-thirds of U.S. adults sleep hours in a 24-hour period, an estimated 83.6 million U.S. adults sleep hours. Therefore, clinicians might find a routine discussion of sleep health with their patients as well as the pursuit of explanations for poor sleep health an important component of providing health care. Healthy sleep duration in adults can be promoted by sleep health education and behavior changes, such as setting a pattern of going to bed at the same time each night and rising at the same time each morning; making sure that the bedroom environment is quiet, dark, relaxing, and neither too hot nor too cold; turning off or removing televisions, computers, mobile devices, and distracting or light-emitting electronic devices from the bedroom; and avoiding large meals, nicotine, alcohol, and caffeine before bedtime. Insomnia symptoms, such as trouble falling or staying asleep can usually be resolved with improved sleep habits or psychological or behavioral therapies (10). At present, no professional sleep organizations have issued consensus statements or recommendations about the efficacy or safety of either over-the-counter or prescription sleep aids for improving sleep duration in the general adult population. In addition, strategies to reduce risks associated with shift work and long work hours include designing better work schedules. Evaluation and monitoring of sleep might also be an important function of health care professionals, including sleep specialists. Keeping a 10-day sleep journal or diary about sleep times, napping, and behaviors that affect sleep, such as exercise, alcohol use, and caffeine consumption, might be helpful before discussing sleep problems with a doctor.

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