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Getting Less Than 7 Hours Of Sleep Linked To Shorter Life Expectancy Across America

Study Finds Sleep Threshold Linked to Longevity Across All U.S. Counties

In Brief

  • Sleeping fewer than seven hours a night is associated with shorter life expectancy in all 3,000+ U.S. counties examined—independent of income, healthcare access, or geography.

  • From 2019–2025, insufficient sleep was the second-strongest predictor of reduced life expectancy after smoking, outranking physical inactivity and diabetes.

  • Adjacent counties often show stark differences in sleep habits and corresponding multiyear gaps in life expectancy.

  • The relationship between inadequate sleep and mortality remained stable throughout the COVID-19 pandemic and after controlling for obesity, smoking, and other health risks.

Americans who regularly get less than seven hours of sleep may be shortening their lives, according to a sweeping analysis of sleep patterns and life expectancy covering every county in the United States. The connection persisted across wealthy suburbs, rural communities, medically underserved regions, and major metropolitan areas.

Researchers reviewed county-level sleep data from more than 3,000 counties between 2019 and 2025, comparing average self-reported sleep duration to local life expectancy. Counties with higher rates of insufficient sleep almost universally showed lower life expectancies. This pattern was consistent across nearly every state and every year in the dataset—even when factoring in smoking, obesity, and physical inactivity.

The findings, published in SLEEP Advances, suggest that sleep plays a major role in community health regardless of socioeconomic conditions. In the first analysis, insufficient sleep emerged as the second-strongest predictor of reduced life expectancy after smoking. In a follow-up model that added obesity and diabetes, both smoking and obesity showed stronger associations, but sleep remained a significant predictor.

County-Level Sleep Patterns and Longevity

The study, led by Oregon Health & Science University, drew on responses from the CDC’s Behavioral Risk Factor Surveillance System, a large monthly telephone survey. Respondents answered a single question: “On average, how many hours of sleep do you get in 24 hours?”

Counties where more residents reported fewer than seven hours of sleep had noticeably shorter life expectancies. In Oregon, for example, counties with higher rates of insufficient sleep showed measurably lower life expectancies than neighboring counties with more adequate sleep—a pattern replicated nationwide. In 2025, only three states did not show a strong correlation, and similar trends were observed from 2019 through 2024.

Comparing Sleep to Other Health Risks

Researchers assessed sleep alongside a wide set of mortality risk factors, including smoking, obesity, diabetes, physical inactivity, food insecurity, lack of insurance, unemployment, educational attainment, and community social connectedness.

Smoking showed the most powerful association with reduced life expectancy. Sleep insufficiency ranked second in the initial model and remained a robust predictor even after adjusting for obesity and diabetes. The findings underscore sleep as a major, modifiable factor in community health—on par with other well-established risks.

Life Expectancy Gaps Between Neighboring Counties

The granular, county-level analysis revealed striking disparities. In some places, one county reported that 40% of residents slept too little, while a neighboring county reported only 25%. These differences corresponded with life expectancy gaps spanning several years.

Because sleep duration is modifiable, the researchers note that targeted interventions—such as adjusting school start times, changing workplace scheduling practices, educating shift workers, or running public awareness campaigns—could help communities boost longevity.

Millions of Americans regularly sleep less than seven hours, according to long-running data from the National Sleep Foundation. Until now, however, the connection between insufficient sleep and life expectancy had not been demonstrated so clearly at the local level.

“I didn’t expect it to be so strongly correlated to life expectancy,” said senior author Andrew McHill, Ph.D., an associate professor at Oregon Health & Science University. “We’ve always thought sleep is important, but this research really drives that point home: People should strive to get seven to nine hours of sleep if at all possible.”

Disclaimer

This article summarizes observational research that identifies associations but does not prove that insufficient sleep directly causes shorter lifespans. The analysis does not account for individual medical conditions, medication use, or specific sleep disorders. People concerned about their sleep should seek medical advice rather than rely solely on population-level findings.

Paper Notes

Study Limitations

The study relies on self-reported sleep duration from telephone surveys, which may be imprecise. The BRFSS question also groups everyone sleeping seven hours or more together, including people who sleep nine hours or more—a category linked in previous research to its own health risks. This may have diluted the strength of the association.

The dataset lacked details on the underlying causes of short sleep, such as sleep apnea, shift work, psychiatric conditions, caregiving demands, or personal lifestyle choices. Sleep apnea, in particular, may drive mortality risk in older adults. The researchers also had no data on actual dietary habits, which may mediate the relationship between sleep and health.

The study period (2019–2025) overlapped with the COVID-19 pandemic, which altered sleep patterns nationwide. Whether pandemic-related changes influenced the results is unclear, though consistent associations were observed across all years.

As an observational study, it cannot exclude unmeasured confounders or establish causation.

Funding and Disclosures

The study was supported by NIH grants R01HL156948, R01HL169317, and T32HL083808; the Oregon Health & Science University School of Nursing; and the Oregon Institute of Occupational Health Sciences, funded through the State of Oregon (ORS 656.630).
Andrew W. McHill reports consulting for Pure Somni Inc. and Portland Public Schools. No other authors reported conflicts of interest.

Publication Details

Kathryn E. McAuliffe, Madeline R. Wary, Gemma V. Pleas, Kiziah E.S. Pugmire, Courtney Lysiak, Nathan F. Dieckmann, Brooke M. Shafer, and Andrew W. McHill, all of Oregon Health & Science University.
“Sleep insufficiency and life expectancy at the state-county level in the United States, 2019–2025,” SLEEP Advances (Oxford University Press), published December 8, 2025. DOI: 10.1093/sleepadvances/zpaf090.

Data available at County Health Rankings.
Open access under a Creative Commons Attribution-NonCommercial-NoDerivs license.

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