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Study finds sleep threshold linked to life expectancy regardless of income or location
In a nutshell
- Sleeping less than seven hours a night is associated with reduced life expectancy in all of the more than 3,000 U.S. counties studied, regardless of income level, access to health care, or urban or rural location.
- Insufficient sleep was ranked as the second-biggest predictor of reduced life expectancy after smoking in a study of county-level data from 2019 to 2025, ahead of physical inactivity and diabetes.
- Neighboring counties may exhibit vastly different sleep patterns and corresponding differences in life expectancy of several years, presenting potential targets for local public health measures.
- The link between insufficient sleep and mortality remained consistent across all years of the study, including during the COVID-19 pandemic, and persisted even when the researchers controlled for obesity, smoking and other underlying health factors.
Americans who regularly sleep less than seven hours a night may have their lives shortened, according to an extensive study that looked at sleep patterns and life expectancy in countries around the world. every county in the USA. This connection holds whether someone lives in an affluent suburb or rural town, or has access to top-notch healthcare or no healthcare at all.
The researchers analyzed data from more than 3,000 counties between 2019 and 2025, comparing reported sleep duration with life expectancy in every area. Counties with more residents sleeping less than seven hours a night consistently showed lower life expectancy. This pattern emerged in nearly every state, year after year, even when researchers controlled for other serious health risks such as smoking, obesity and physical inactivity.
Results published in DREAM Achievementswere consistent regardless of where people lived or their socioeconomic status. Sleep insufficiency predicted reduced life expectancy in both high- and low-income counties, urban centers and isolated rural areas. Sleep is considered one of the strongest predictors of longevity of all lifestyle factors studied, second only to smoking in the original analysis.
Sleep and life expectancy: a county-level analysis
A research team from Oregon Health & Science University examined responses from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, a massive telephone survey conducted monthly across the country. Participants answered a simple question: “On average, how many sleep hours will you receive it in 24 hours?
Counties where the majority of the population slept less than seven hours had noticeably lower life expectancies. In Oregon, counties with higher rates of insufficient sleep tended to have noticeably shorter life expectancies than counties where fewer residents reported sleep deprivation. insufficient sleep. This pattern creates a visible gradient across the state's map, with some counties performing noticeably better than their neighbors.
The picture was repeated throughout the country. In 2025, the researchers found a strong correlation in all but three states, with similar associations appearing every year from 2019 to 2024.
How does insufficient sleep compare to other health risks?
When the research team compared several risk factors for mortality, they found that sleep insufficiency was as good as established predictors. The analysis included indicators of smoking, obesity, diabetes, physical inactivity, food insecurity, lack of health insurance, unemployment, high school completion, and social connections.
Smoking showed the strongest association with reduced life expectancy. Son came in second place, ahead of obesitydiabetes and physical inactivity. When the researchers conducted a second analysis that included obesity and diabetes as additional factors, both smoking and obesity showed a stronger association with life expectancy than sleep insufficiency. However, inadequate sleep remained a significant predictor even in this expanded model.
These results challenge assumptions about what drives longevity at the community level. Although access to healthcare, education and economic opportunity No matter, the amount of sleep residents get seems equally important.
Gap in life expectancy between neighboring counties
Breaking down the analysis to the county level reveals differences between neighboring communities. In some counties, 40% of residents are sleep deprived, while in the next county it is only 25%. These differences correspond to gaps in life expectancy that can amount to several years.
Local health departments and policymakers can now identify specific areas where sleep interventions may have the greatest impact. Unlike some mortality risk factors associated with individual genetics or long-term environmental exposure, sleep duration can be modified. Communities could address the problem of insufficient sleep through workplace policies. school start timepublic awareness campaigns or initiatives targeting shift workers.
Millions of Americans report sleeping regularly less than seven hours. The National Sleep Foundation has been documenting this trend for years, but tying it to life expectancy at such a detailed geographic level is new.
The study adds sleep to the list of modifiable factors that communities can influence to increase life expectancy. Whether someone lives in a prosperous city or in a poor city countrysidegetting enough sleep makes a difference in how long they live.
“I didn’t expect it to correlate so strongly with life expectancy,“We've always thought sleep was important, but this study really drives home that point: People should really aim to get seven to nine hours of sleep if at all possible.”
Disclaimer: This article is based on observational studies that show a link between sleep duration and life expectancy, but cannot prove that insufficient sleep directly leads to shorter life expectancy. The results do not take into account individual medical conditions, prescribed medications, or specific sleep disorders that may affect both sleep duration and health status. Readers concerned about their sleep patterns should consult their healthcare professionals rather than make medical decisions based solely on population-based studies. This article is for informational purposes only and does not constitute medical advice.
Paper notes
Limitations of the Study
The researchers acknowledge several limitations in their analysis. Sleep data were obtained from self-reported telephone surveys rather than from objective sleep measures, which may be less accurate. In the Behavioral Risk Factor Surveillance System question, everyone who slept seven or more hours together was grouped together, meaning people who slept excessively (nine or more hours) were included among those who slept the recommended seven to eight hours. Previous research has shown that very long sleep duration may also be associated with health risks, so this grouping may have weakened the true strength of the association between insufficient sleep and mortality.
The dataset lacked information on potential causes of insufficient sleep, including diagnosed sleep disorders such as sleep apnea, shift work schedules, mental illness, caregiving responsibilities, or personal choices. In particular, sleep apnea has been suggested to increase the risk of mortality among older adults. The analysis was unable to account for actual dietary choices, which may serve as a mechanism linking sleep to health outcomes, as adequate sleep has been associated with healthier food choices in previous studies.
The study covered the period from 2019 to 2025, a period affected by the COVID-19 pandemic. Stay-at-home orders and remote working have likely changed sleep patterns across the population, with studies documenting changes in both sleep duration and timing worldwide during this period. It is difficult to determine from the available data whether these pandemic-related changes affected the results, although similar associations between insufficient sleep and life expectancy were observed in all years analyzed.
The study design does not allow researchers to rule out unmeasured confounding variables or establish a definitive cause-and-effect relationship. Although the analysis controlled for many known risk factors for mortality, there may be other potential influences on both sleep and lifespan that were not captured in the data set.
Funding and Disclosure
This work was supported by National Institutes of Health grants R01HL156948, R01HL169317, and T32HL083808, the Oregon Health & Science University School of Nursing, and the Oregon Institute of Occupational Health through funds from the Oregon Division of Consumer and Business Services (ORS 656.630). Andrew W. McHill reports consulting for Pure Somni Inc and Portland Public Schools. No other authors reported financial or non-financial conflicts of interest.
Publication details
Catherine E. McAuliffe, Madeline R. Wery, Gemma V. Ples, Keezia E.S. Pugmire, Courtney Lysiak, Nathan F. Diekmann, Brooke M. Schafer, and Andrew W. McHill, all affiliated with Oregon Health and Science University. “Sleep Inadequacy and Life Expectancy at the State and County Levels in the United States, 2019–2025,” published December 8, 2025 in DREAM Achievements (Oxford University Press). DOI: 10.1093/sleepadvances/zpaf090
Data Availability: The data underlying this article is available at https://www.countyhealthrankings.org/ Open access: This article is published under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs license, which permits non-commercial reproduction and distribution provided the original work is not modified. The article received full funding for open access publication through the SLEEP Advances Trainee Publication Fee Waiver Award program, funded and administered by the Sleep Research Society.
