Best and Worst States for Sleep

If you don't get enough sleep, you have plenty of company. More than 11 percent of adults said there was not a single day in the previous month when they got enough shuteye, government researchers reported.

Another 17 percent reported insufficient sleep during half or more of the previous month, according to L.R. McKnight-Eily, of the U.S. Centers for Disease Control and Prevention.

He and colleagues reported their findings in the Oct. 30 issue of the CDC's Morbidity and Mortality Weekly Report (MMWR).

All told, only 31 percent of respondents said they had gotten enough sleep every day in the past month, according to 2008 data from CDC's Behavioral Risk Factor Surveillance System, which surveyed some 404,000 individuals in all 50 states, the District of Columbia, and three island territories.

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"The importance of chronic sleep insufficiency is under-recognized as a public health problem, despite being associated with numerous physical and mental health problems, injury, loss of productivity, and mortality," McKnight-Eily and his colleagues noted in the report.

They cited data from earlier surveys indicating that nearly 30 percent of U.S. adults sleep less than seven hours per night on average and that from 50 to 70 million have chronic sleep disorders.

As part of the multi-subject survey, respondents were asked on how many days during the previous 30 they got sufficient sleep and rest: zero, one to 13, 14 to 29, or 30 days.

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The researchers found significant geographic variations: Southeastern states had the highest proportion individuals who said they never got enough sleep the previous month.

West Virginia led the list, with 19.3 percent of respondents reporting insufficient sleep for the entire month. Other states with high numbers in this category — at least 13.1 percent reporting insufficient sleep every day — included Kentucky, Tennessee, Mississipi, Alabama, Georgia, Florida, Missouri, and Oklahoma.

The state with the lowest proportion of people who couldn't or didn't sleep was North Dakota, where only 7.4 percent said they did not get enough sleep at all the previous month. Other states with low proportions of non-sleepers (less than 9.7 percent) included California, Oregon, Idaho, Utah, Colorado, Nebraska, and Michigan.

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Variations in the proportion of respondents who got enough sleep every day showed a different pattern. Some 27.6 percent of West Virginians and 29.4 percent of respondents in North Dakota were in this category.

The CDC researchers had no direct explanation for the geographic patterns, but they identified several other factors predicting relatively poor sleep: unemployment, inability in work, lack of college education, and a relationship terminated by divorce, separation, or death.

Of these factors, inability to work appeared to have the strongest effect, with about 26 percent of such individuals reporting insufficient sleep for the entire month and another 22 percent saying they slept poorly for at least 14 days.

Almost 51 percent of those surveyed in Puerto Rico said they never had trouble sleeping, while the state with the lowest proportion of satisfied sleepers was Ohio, at 27.1 percent.

The MMWR editors recommended in an editorial note that doctors routinely ask patients about their sleep habits and that those reporting significant problems should be advised of behavioral strategies to improve their sleep.

For patients with severe or persistent problems, medications and referrals to sleep specialists may be warranted, the editors said.

The MMWR editors also suggested that the geographic variation may be related to occupational factors, such as the prevalence of rotating and/or extended shifts, and to other factors such as depression and obesity, which can also affect sleep.

Women were slightly more likely than men to report never getting enough sleep (12.4 percent versus 9.9 percent).

Seniors 65 and older were most satisfied with their sleep, with 57 percent saying they got enough every day and just 7 percent reporting insufficient sleep every day.

Respondents in the 25-34 age group reported the worst sleep. Twenty-two percent of the young adults reported 30 days of good sleep and 14 percent reported 30 days of poor sleep.

Limitations of the report included the fact that the survey relied on respondents' subjective interpretations of "enough sleep and rest," meaning that the results can't be compared directly with studies of objective sleep duration.

Also, the survey was conducted by telephone, and therefore excluded some important populations, including those in institutional residences and those without landline phones.

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