PODCAST: Sleep Difficulties & Patterns Among Americans

June 30, 2022


HOST: The American Academy of Sleep Medicine recommends between 9 and 12 hours of sleep for children between ages 6 and 12, and 8 to 10 hours of sleep for teens ages 13 to 18.  However, only two-thirds of school-age children meet these recommendations.

At the same time, the American Academy of Sleep Medicine and the Sleep Research Society recommend that adults receive at least 7 hours of sleep per night, and yet, more than a quarter of adults do not meet this recommendation. Signs of good sleep quality include taking less time to fall asleep and not waking up often or for long periods of time.

Last week, NCHS released two new reports on sleep habits among children and adults, using data from the 2020 National Health Interview Survey – or NHIS.

Today, we’re joined by the lead author of the report on adults, Dzifa Adjaye-Gbewonyo, who is also a co-author on the report on children’s bedtime habits.

HOST:  OK Dzifa, thank you for joining us.  Could you talk a little bit about why your team conducted these analyeis on sleep and sleep behaviors?

DAG:  Sure.  So the 2020 National Health interview survey or NHIS was the first time that data on sleep had been collected on adults since the survey was redesigned in 2019, and we wanted to be able to provide updated information on adult sleep.  The sleep questions had also changed slightly from earlier versions of the NHIS and the 2020 survey was also the first time that sleep data had ever been collected on children in the NHIS.  So we wanted to be able to analyze the adult and child sleep content and produce estimates for some of these measures.

HOST:  So – second question – just stepping back… In a general sense, why is sleep an important part of a healthy lifestyle?

DAG:  So sleep is vital for health and well-being.  Inadequate sleep and issues with falling or staying asleep have been associated with poor health outcomes such as high blood pressure, heart disease, diabetes, obesity and even mortality.  Insufficient sleep also affects children’s physical and mental health, and increases the likelihood of cognitive and behavioral issues, Type II diabetes, obesity and injuries.

HOST: OK and what is the recommended amount of sleep for an adult?

DAG:  So for adults this suggested amount of sleep is at least seven hours a night based on recommendations from the American Academy of Sleep Medicine and the Sleep Research Society.

HOST: OK and what about the what is recommended for children?

DAG:  For children, the American Academy of Pediatrics recommends between 10 to 16 hours of sleep for children under five years, 9 to 12 hours for children 6 to 12 years, and eight to 10 hours for adolescents aged 13 to 18.

HOST:  In your study on adults how did you define sleep difficulties?

DAB: We defined, we looked at two measures for sleep difficulties which we called “trouble falling asleep” and “trouble staying asleep” and those were based on survey questions in the questionnaire so the question on trouble falling asleep was based on a response of if adults answered “most days” or “every day” to the question “During the past 30 days how often did you have trouble falling asleep?” and similarly for” trouble staying asleep” it was also based on a response of “most days” or “every day” to the question “During the past 30 days how often did you have trouble staying asleep?”

HOST: OK now getting into your studies, what were the key findings in your study on adults?

DAB: We found that one in seven adults in the US had trouble falling asleep and about 18% of adults had trouble staying asleep.  These sleep difficulties were more common in women than men, and older adults aged 65 and over had less trouble falling asleep while younger adults aged 18 to 44 had less trouble staying asleep.  Problems falling and staying asleep decreased as family income increased and as place of residence became more urban.  Sleep difficulties also varied by race and ethnicity stand by education level.

HOST: Now your study used 2020 data – was there any insight about how the pandemic impacted sleep patterns?

DAG:  We looked at 2020 data as a whole, so analysis on changes in sleep patterns during the pandemic were beyond the scope of this report.  There is more specific information about when the data were collected, but it might be difficult to tease out the reasons for any changes observed across time periods.  Especially because the data collection process also changed during the pandemic. Prior to 2020 data on sleep were last collected in the 2018 NHIS.  However, they may not be directly comparable to 2020 data due to changes in the survey questions.

HOST:  Would it be accurate to say that your findings here suggest that economic or money concerns have an impact on people sleep habits?

DAG:  Well we can say that there is a link between economic factors and sleep difficulties and that complaints of trouble falling and staying asleep and adults are lower with increasing family income, but we cannot say with certainty what the direction of this impact is from these data alone.  For example, a family’s economic situation may affect someone’s ability to fall or stay asleep, and sleep difficulties could also have some effects on economic status.  So since the survey is a snapshot in time either or both impacts may be possible.

HOST:  Right and anecdotally that would certainly make sense.  So your other study in which you were a co-author on looked at children’s bedtime habits.  How important is it bedtime routine for kids?

DAG:  Studies show that children who have regular bedtimes are more likely to get the amount of sleep they need.  And sleep routines are also linked to other outcomes in children.  For instance, better cognitive performance and a lower risk of obesity.  So bedtime routines are quite important for children.

HOST:  So does your study show that kids are getting the recommended amount of sleep then?

DAG:  Well our data did not look specifically at the amount of sleep children are receiving, but based on other sources just under 2/3 of children get the recommended amount of sleep.  So about 1/3 of children in the U.S. do not get enough sleep.

HOST:  And how does your study define a regular bedtime for kids?

DAG:  For a regular bedtime for children, we define that based on responses to the question “In a typical school week, how often does the child go to bed at the same time?” and so the response options were “Never,” “Some days,” “Most days,” or “Every day,” and we use “Most days” or “Every day” to define having a regular bedtime.

HOST:  What does that study tell us about family structure and bedtime habits and children?

DAG:  Well our results showed that there does seem to be a difference in regular bedtime habits depending on children’s family structure.  Children living in single parent families were less likely to have a regular bedtime every day or most days compared with children living in two-parent families.

HOST:  And which children are more likely not to have a structured bedtime routine?

DAG:  Older children aged 12 to 17 are more likely to not have a regular bedtime, as well as Hispanic and non-Hispanic black children, children living in families with lower incomes, and children to live in communities that are more socially vulnerable.

HOST:  One would assume, too, if they have parents who work evenings or something, or a parent travels a lot, that that would have an impact on bedtime routine?

DAG:  Yeah that’s possible – we didn’t get to look specifically at work schedules and travel but that would be something to look into to tease out some of those impacts.

HOST:  OK so do you have any other take home messages about either report you’d like to emphasize?

DAG:  Well, I think one thing that we would like to emphasize we hope is that these reports will improve our understanding of sleep difficulties in adults and of children’s bedtime routines.  So we hope that they can be useful sources of information that can help inform future research and also inform sleep interventions and targeting sleep interventions for subgroups that may be more at risk.


HOST: NCHS is part of a team of federal agencies, led by the Census Bureau, that collaborate on the Household Pulse Survey, which has produced mental health and health care access data, along with several other topics, during the pandemic.  On June 22, the Pulse Survey for the first time included data on “long COVID,” defined as “symptoms lasting three or more months after first contracting the virus, and that they didn’t have prior to their COVID-19 infection.”  The first round of data, collected from June 1st to June 13 showed that nearly 1 in 5 Americans who have had COVID-19 still have long COVID.

NCHS released two other new reports this month as well.  On June 23, data from the National Ambulatory Medical Care Survey was examined in a new report on Health Centers in the United States.  The report found that a third of the visits to these health centers were for preventive care.  Another third of visits were due to chronic problems and the other third were due to new problems.  6 in 10 health care center visits involved screening, exams, and health education or counseling.  4 in 10 visits involved lab tests of some kind.  Most of these visits to health care centers were paid for by Medicaid.

And finally, this month NCHS released a report on maternal health characteristics and infant outcomes to women born both in and outside the United States. The report reveals that over 1 in 5 women who gave birth in the United States were born outside the U.S.  Over half of these women born outside the U.S. were from Latin America, who accounted for 12% of all women giving birth in 2020.  Over a quarter of women born outside the U.S. were born in Asia, and accounted for 6% of all births.

QuickStats: Percentage of Adults Aged ≥18 Years Who Sleep <7 Hours on Average in a 24-Hour Period, by Sex and Age Group

March 11, 2022

Overall, 28.3% of men and 27.2% of women aged ≥18 years slept <7 hours on average within a 24-hour period.

Among persons aged 18–44 years, men (28.8%) were more likely to sleep <7 hours compared with women (25.6%).

Among adults aged 45–64 years, the percentage was similar for men (31.1%) and women (30.7%).

However, among those aged ≥65 years, women (25.5%) were more likely than men (22.6%) to sleep <7 hours.

Source: National Center for Health Statistics, National Health Interview Survey, 2020. https://www.cdc.gov/nchs/nhis/index.htm


QuickStats: Percentage of Currently Employed Adults Aged 18 Years or Older Who Reported an Average of 6 Hours of Sleep or less per 24-Hour Period, by Employment Category

April 24, 2020

The percentage of employed adults who reported an average of 6 hours or less of sleep per 24-hour period increased from 28.4% during 2008–2009 to 32.6% during 2017–2018.

During this period, increases were noted among private sector employees (29.5% to 33.3%), government employees (28.8% to 32.8%), and the self-employed (24.3% to 31.4%).

A lower percentage of the self- employed reported 6 hours or less of sleep compared with private sector and government employees during 2008–2009.

The smaller differences by employment categories noted during 2017–2018 were not statistically significant.

Source: National Health Interview Survey, 2008–2009 and 2017–2018. https://www.cdc.gov/nchs/nhis.htm.


QuickStats: Percentage of Adults Aged 18 Years or Older Who Took Medication To Help Fall or Stay Asleep Four or More Times in the Past Week, by Sex and Age Group

December 13, 2019

During 2017–2018, 8.2% of adults aged 18 years or older took medication to help fall or stay asleep four or more times in the past week (6.6% for men and 9.7% for women).

Among men, the percentage who took medication for sleep four or more times in the past week increased with age from 3.8% among those aged 18–44 years to 10.7% among those aged 65 years or older.

Among women, the percentage increased from 5.8% for those aged 18–44 years to 12.7% among those aged 45–64 years and 13.2% among those aged 65 years older.

Across all age groups, the percentage was higher among women than men.

Source: National Center for Health Statistics, National Health Interview Survey, 2017 and 2018. https://www.cdc.gov/nchs/nhis.htm.


QuickStats: Age-Adjusted Percentages of Adults Aged 18–64 Years Who Never Felt Rested in the Past Week by Sex, Race, and Hispanic Origin — National Health Interview Survey, 2017–2018

October 25, 2019

During 2017–2018, among persons aged 18–64 years, women were more likely than men to report they never felt rested in the past week overall (21.1% versus 14.3%) and in each race and Hispanic origin group.

Non-Hispanic white men (16.0%) were more likely to report they never felt rested than were Hispanic men (11.1%), non-Hispanic black men (12.0%), and non-Hispanic Asian men (9.7%).

Non-Hispanic white women (23.0%) were more likely to report they never felt rested than were Hispanic women (19.0%), non-Hispanic black women (18.9%), and non-Hispanic Asian women (13.7%).

Source: National Center for Health Statistics, National Health Interview Survey, 2017–2018. https://www.cdc.gov/nchs/nhis.htm.


Sleep Duration and Quality Among Women Aged 40-59, by Menopausal Status

September 7, 2017

Questions for Anjel Vahratian, Ph.D., Author of “Sleep Duration and Quality Among Women Aged 40-59, by Menopausal Status

Q: What made you decide to conduct this study on sleep duration and sleep quality for this group of women?

AV: My research focuses on the health of women as they age and transition from the childbearing period. During this time, women may be at increased risk for chronic health conditions such as diabetes and cardiovascular disease. As insufficient sleep is a modifiable behavior that is associated with these chronic health conditions, I wanted to examine how sleep duration and quality varies by menopausal status.

Q: Was there a finding in your new study that surprised you, and if so, why?

AV: I was surprised to learn that nearly one in two women aged 40-59 did not wake up feeling well rested four times or more in the past week and that postmenopausal women aged 40-59 were more likely to experience disruptions in sleep quality compared with premenopausal women in the same age group.

Q: How did the women from your survey track their sleep behavior; for example, did they use a wearable sleep tracker?

AV: In this report, information on sleep duration and quality are based on self-report. Trained interviewers asked survey participants on average, how many hours of sleep did they get in a 24-hour period. In addition, they asked participants to recall how many times they had problems falling asleep and staying asleep and how many days they woke up not feeling well rested in the past week.

Q: In addition to menopausal status, do you have any other lifestyle information that could impact women’s sleep quality for this age group; for example, shift work employment or having infants or very young children in the home?

AV: While this report did not specifically look at other lifestyle factors that could affect women’s sleep duration and quality – other than age and menopausal status — my colleagues released a report in January 2016 on sleep duration and quality by sex and family type. This report looked at the presence of young children in the household. In addition, we have produced estimates of sleep duration and quality across several sociodemographic characteristics such as race and ethnicity, education, poverty status, marital status, and region.

Q: This report seems to offer just a single year of data – 2015; do you have any trend data to compare these findings to previous years, or any newer data?

AV: Unfortunately, we do not have any long-term trend data on sleep duration and quality among women aged 40-59 by menopausal status. The National Health Interview Survey, or NHIS, has included questions on sleep duration and quality since 2013, while the questions on menopausal status were a part of the 2015 NHIS cancer control supplement.

Q: What is the take-home message from this report?

AV: I think the real take-home message of this report is that sleep is critical for optimal health and wellbeing, and it is a modifiable risk factor for diabetes and cardiovascular disease. As sleep duration and quality vary by menopausal status, it is an area for targeted health promotion for women at midlife.