Globally, inadequate sleep is widespread in daily life, where its effect on life expectancy at the county level in the United States has not been clearly defined. Our analysis shows that even after accounting for common behavioral factors linked to mortality, insufficient sleep remains strongly associated with reduced life expectancy across U.S. counties.
These findings underscore the critical role of adequate sleep, independent of income, healthcare access, or geographic setting. This study emphasizes the importance of sleep in contributing to life expectancy in various communities, irrespective of income, health care access, and whether a particular county is urban or rural.
This study, conducted between 2019 and 2025, reveals that there is an evident and steady association between inadequate sleep and reduced life expectancy across the United States. The researchers used the data provided by the Centers for Disease Control and Prevention, the Behavioral Risk Factor Surveillance System, which conducts a survey of health behaviors in each of the 3141 counties. They also focused on the proportion of adults who do not sleep more than 7 hours within 24 hours of their day and contrasted them with life expectancy trends.
The findings demonstrate that the majority of the states revealed a significant negative correlation between inadequate sleep and life expectancy. In 2025, this link was observed in all but three states, and equivalent results were observed between 2019 and 2024, where between 84% and 100% of states had significant relationships in the four years. Countries with an insufficient sleep rate tended to have an extended life expectancy.
Controlling the influence of other health-related behaviors through mixed-effects models, including smoking, physical inactivity, food insecurity, insurance status, unemployment, social connections, and high school completion, the study has still concluded that the influence of sleep was significant. Lack of sleep was associated with poor life expectancy. Sleep lack in the statistical model was estimated at b = -0.17, which is not as large as smoking, having b = -0.31. The model variables were all statistically significant.
The researchers also determined the possibility of obesity and diabetes that may be associated with insufficient sleep, modifying the outcomes. Sleep insufficiency was still significant even after controlling with these mediators with b = -0.08, which indicated that insufficient sleep is a factor on its own with respect to shorter life expectancy. The effects of obesity and smoking were stronger in this and the long model (b = -0.18 and b = -0.28, respectively).
Data on 3143 counties of the country were used in the study, making the findings more powerful. Since such a large population is covered, the data has been representative in terms of geographic differences, income, and community health access. Nevertheless, the linkage between lack of sleep and life expectancy was observed to be consistent in almost every region.
The researchers have observed that there are limitations. Certain such factors as shift work, unreported health conditions, sleep disorders, or the temporary nature of unemployment or loss of insurance might have affected the data and were not fully considered. Moreover, the COVID-19 pandemic changed the sleep time and duration of many people and could have influenced survey outcomes. Nevertheless, the trend of low sleep and life span was constant during the pandemic years.
Due to the county-level breakdown of the results, local leaders and policymakers can utilize this information to develop community-level interventions, particularly in areas with high sleep insufficiency. The authors urge the need to conduct future studies to understand the mechanisms that relate insufficient sleep to early mortality, as well as to come up with effective measures to promote sleep in the country.
References: McAuliffe KE, Wary MR, Pleas GV, et al. Sleep insufficiency and life expectancy at the state-county level in the United States, 2019-2025. Sleep Advances. 2025. doi:10.1093/sleepadvances/zpaf090
