Tyler Le/BI
Sleep is the great unifier. Everyone needs it to repair cells, store memories, and balance emotions. It also helps us solve complex problems — ever need to just "sleep on it"?
Hustle culture tells us sleep is for the lazy. CEOs such as Apple's Tim Cook and Robinhood's Vlad Tenev tout their limited sleep schedules. Gordon Ramsay attributes his success to long workdays and little sleep. One woman told Business Insider she had saved tens of thousands of dollars by juggling two full-time jobs and sleeping for just three hours each night.
But while different people tend to feel more alert at different times of day, the science is clear: Everyone needs at least seven to nine hours of sleep each night in order to function properly. Teenagers need a full eight to 10 hours. And there is emerging evidence that women, who historically have been largely excluded from sleep studies, need more rest than men. When we don't get enough sleep, it can influence everything from how much money we make to our likelihood of developing dementia, heart disease, and diabetes.
Yet more than 85 million Americans are running on fumes. They don't get enough sleep, and the problem has grown worse over time.
The internet is littered with advice on how to get enough sleep: Keep your phone in a different room. Don't drink alcohol before bed. Turn the thermostat down. There's even specialized advice for couples: Maybe separate bedrooms will help. Those with extra cash can take things a step further. Drake bought a $395,000 horsehair mattress that supposedly improves circulation. Michael Phelps slept in a hyperbaric chamber that simulated being at 8,000 feet. And expensive products such as Oura's smart ring and Whoop's smart band promise to use data to improve your sleep.
These tactics imply that proper "sleep hygiene" (and expensive products) can fix chronic sleep deprivation. In fact, researchers used to believe that people in cities — where sleep impediments like noise pollution, bright lights, cramped conditions, and poor airflow are common — got the worst sleep. But an analysis of 2020 data from the Centers for Disease Control and Prevention by my team at American Inequality, a data-driven newsletter, has found that the most underslept people live in low-income, rural areas, primarily in the South. Residents of West Virginia, Kentucky, and Alabama regularly get the least amount of sleep — and it's not because they don't have horsehair mattresses.
Researchers have found that stress is one of the strongest indicators of poor sleep. Economic stress, in particular: Americans in poverty report getting the least amount of sleep. In a 2022 survey, 87% of Americans polled said they lost sleep worrying about their finances. And in a 2020 study, 13% of newly unemployed people said they got four hours of sleep or less a night, half of what the average employed person gets. In counties where about half the population doesn't get enough sleep, many of which are in Alabama, unemployment rates are twice as high as the US average, and median household incomes hover around $35,000.
Mingo County, tucked in the southwestern corner of West Virginia, is the most sleep-deprived county in the most sleep-deprived state. One-quarter of Mingo residents live in poverty — double the national average. On top of that, the county struggles with poor health, another major contributor to poor sleep. Nearly half of Mingo residents are obese (10 percentage points higher than the national average) and one in three smoke cigarettes (triple the national average). Mingo is also home to the highest rates of hypertension and heart disease in the state.
On the other end of the spectrum is Boulder County, Colorado, which you might call the sleep capital of America; 80% of residents reported being well rested. Here, the unemployment rate is one of the lowest in the state, and the median household income falls at $92,000. It's also one of the healthiest counties in country.
In major cities such as Manhattan and San Francisco, where the median incomes are $90,000 and $126,000 respectively, seven in 10 people reported getting sufficient sleep. Money may not buy happiness, but it does seem to buy better sleep.
Mental and physical health, which tend to be worse in lower-income areas, also contribute to sleep inequality. In our analysis, we overlaid the CDC's sleep data with a CDC survey on mental health and found a 79% correlation between mental-health problems and poor sleep. A 2022 study by Columbia researchers found a similar relationship. According to Johns Hopkins, three-quarters of people with depression say they struggle to fall asleep or stay asleep. Other research has found that half of people with chronic pain and as many as half of people with cancer don't get enough sleep.
These factors build on each other. Economic stress, depression, and physical pain make it harder to sleep, and the lack of sleep makes all these situations more difficult to manage. Americans with sleep disorders earn an average of $2,500 less each year than their well-rested peers and are more likely to have to leave their jobs. Researchers at Johns Hopkins University found that poor sleep increased the likelihood of developing the very diseases that keep people awake at night in the first place: cancer, dementia, heart disease, type 2 diabetes, and obesity. It also accelerates the spread of certain cancers. Once these negative feedback loops begin, it can make it harder for people to dig out of cycles of inequality.
To fix their sleep problems, people often resort to outlandish sleep hacks like using a red light bulb in their bedroom or taking a cold shower before bed. One of the more common approaches, the "military sleep method," which relies on breathwork and relaxation techniques, isn't backed up by much research.
Some advice, including building a regular sleep schedule, breathing filtered air, and getting daily exercise, will probably help you sleep better. But these individual hacks tend to distract from what's actually plaguing the most sleep-deprived Americans. If you lose your job or suffer from chronic pain, trying not to think for 10 seconds isn't going to do much.
Big, structural changes such as better access to affordable healthcare, expanding income-support programs like the child tax credit, and implementing mental-health programs in schools would go a long way to ending the sleep-deprivation doom loop. But in the meantime, there are a few smaller fixes, such as moving school start times to 8:30 a.m. In the most sleep-deprived states, schools tend to start earlier, beginning at 7:40 a.m. on average in Mississippi and 7:49 a.m. in Alabama. Students slog through school in a fog of sleep deprivation, which affects their ability to learn. Pushing back start times can improve grades by 4.5%, or the equivalent of three months of student learning.
According to the CDC, 70% of high schoolers are not getting enough sleep. One study found that delaying school start times to 8:30 a.m. or later for high schools and elementary schools would add $83 billion to the US economy within a decade because of students' improved performance in school. California and Florida are already on board, recently passing bills mandating that all public high schools start no earlier than 8:30 a.m.
Another way forward is through labor regulations. In 2003, the Accreditation Council for Graduate Medical Education implemented rules limiting work hours for all medical residents to ensure they got enough sleep. Since then, care for patients and doctors' well-being have improved. But more rules are needed — 40% of healthcare workers still weren't getting enough sleep when the CDC last looked at the issue, in 2017. Industries such as transportation also have rules to protect sleep, limiting truck drivers to 11 hours on the road at a time. But there are many professions where people are left to their own devices. In the food-services industry, people juggle inconsistent shifts and low pay that often requires taking on multiple jobs, and 40% of workers don't get enough sleep. Among gig workers, who lack traditional employment protections, inconsistent pay has been found to contribute to worse sleep.
When people start to fall behind on sleep, their social, economic, and physical lives soon begin to suffer. The cycles of inequality deepen, and no amount of red-light therapy can reverse the trend.
Jeremy Ney is the author of American Inequality, a data publication project that spotlights US inequality topics. He was previously a macro policy strategist at the Federal Reserve Bank of New York.