It is estimated that more than 10 million American adults consistently get less than seven hours of sleep every night. For years, public health officials have warned that this amount of rest is insufficient for long-term health. Lack of adequate sleep has been associated with numerous chronic health issues, including heart disease and metabolic disorders, and is linked to an increased risk of early death in adults without diagnosed sleep disorders.
Despite the known risks, major studies on sleep conducted by state or local public health agencies have been scarce. However, research from Oregon Health & Science University has shed new light on this issue by analyzing sleep and life expectancy data at a county level across the United States. Their study, published in SLEEP Advances, found that insufficient sleep is a significant indicator of longevity in the U.S., suggesting that both sleep habits and geographical location contribute to variations in life expectancy.
Measuring Sleep and Life Expectancy County-Wise
The researchers sought to determine whether counties with higher levels of insufficient sleep experience lower average life expectancy compared to those where residents meet recommended sleep guidelines. Utilizing data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), the study analyzed responses from 3,141 counties across 50 states, collected from 2019 to 2025.
Participants were asked about their average daily sleep duration. Those reporting less than seven hours were classified as having insufficient sleep, based on standards set by the American Academy of Sleep Medicine and the Sleep Research Society. The researchers then calculated the percentage of residents in each county who were chronically sleep-deprived and compared these figures to county-level life expectancy estimates.
Analyzing Changes in Health Behaviors Over Time
To identify trends, the researchers employed statistical models that utilized historical data over multiple years. This approach allowed for comparisons within and between counties, even when data was incomplete. The analysis adjusted for various factors known to impact health and longevity, including smoking rates, physical inactivity, food insecurity, unemployment, health insurance coverage, education, social connections, and diabetes. A secondary model also accounted for obesity, which is often associated with chronic sleep deprivation.
By controlling for these variables, the researchers aimed to isolate the unique effect of sleep on life expectancy.
A Similar Trend Across the Nation
The study revealed a strong correlation between sleep duration and average lifespan in most U.S. states. By 2025, only three states did not show a significant correlation. In 2019, 84% of surveyed states demonstrated a strong link between sleep and life expectancy, a figure that rose to all states by 2024. This pattern persisted even during disruptions such as the COVID-19 pandemic.
“In this multi-year study, sleep deprivation was identified as one of the top 5 predictors of premature death,” said Andrew McHill, senior author of the report. “We didn’t realize sleep was so closely tied to life expectancy.”
McHill, an Assistant Professor at Oregon Health Sciences University and a Senior Researcher at the OHSU Institute for Occupational Safety and Health, emphasized the unexpected strength of the association at the county level.
Insufficient Sleep and Mortality Risk
While obesity and diabetes can diminish the impact of sleep deprivation on life expectancy, insufficient sleep remains a predictor of shorter lifespans. The study found that smoking and obesity had the most significant association with poor life expectancy, but sleep was a close contender.
McHill noted that while the link between insufficient sleep and increased mortality risk has been known, the magnitude of the association at the county level was surprising. “The strength of the association between sleep sufficiency and life expectancy was the most impressive part,” he said.
Limitations of the Study
Despite its size, the study had limitations. The BRFSS survey lacks information on shift workers, sleep disorders, and sleep quality, all of which affect health. Additionally, the survey grouped individuals sleeping more than seven hours with those sleeping exactly seven hours, despite excessive sleep being potentially indicative of health issues.
The study also did not directly measure dietary patterns, though it included food insecurity. Despite these limitations, the researchers assert that the dataset’s size and consistency make the conclusions difficult to ignore.
Sleep Should Be a Priority
The findings suggest that insufficient sleep is a public health issue at the community level. High levels of short sleep in counties indicate that targeted public health efforts could have significant impacts. “This study demonstrates there is a need to prioritize sleep as much as what we eat or how we exercise,” McHill stated. “Getting enough sleep will help improve not only how you feel today, but also how long you live.”
Practical Applications of the Research
The study identifies sleep as a modifiable behavior that can enhance population health. Local governments, employers, and healthcare officials can leverage these findings to support sleep education, adjust work schedules, and promote community-wide sleep health. Improving sleep habits in high-risk counties could enhance quality of life and reduce early mortality.
For researchers, these findings expand the understanding of how sleep interacts with social, economic, and environmental factors over time. The research is available in the journal SLEEP Advances.
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