Insufficient sleep is one of the strongest predictors of shorter life expectancy in the U.S., surpassed only by smoking.
That's according to a new nationwide analysis published in the journal SLEEP Advances, led by senior author Andrew McHill, Ph.D., associate professor with Oregon Health & Science University (OHSU).
To explore how sleep habits relate to lifespan, the researchers examined data from surveys conducted by the CDC between 2019 and 2025 across more than 3,000 U.S. counties, according to a press release.
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Sufficient sleep was defined as at least seven hours per night, consistent with guidelines from the American Academy of Sleep Medicine and the Sleep Research Society.
The researchers compared average life expectancy in each county with the proportion of residents reporting sufficient sleep, controlling for traditional predictors of mortality such as smoking, diet, physical inactivity and loneliness.
Counties where more people reported insufficient sleep tended to have lower life expectancy. This pattern held across most states and years studied, even when accounting for other lifestyle factors.
"I didn’t expect it to be so strongly correlated to life expectancy," McHill said in the press release, noting that although sleep’s importance to health is well-established, its association with lifespan exceeded expectations.
"We’ve always thought sleep is important, but this research really drives that point home: People really should strive to get seven to nine hours of sleep if at all possible."
The research builds on a broad body of evidence linking sleep duration to health outcomes, including mortality risk, heart health, immune strength and brain function.
However, this is the first analysis to map the relationship between sleep duration and life expectancy at a detailed, county-by-county level across multiple years, establishing a consistent association across diverse communities, the release states.
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The study did have some limitations, including its reliance on self-reported survey data, which can be subject to reporting bias. It also cannot establish causation and does not explain the biological factors behind the results, the researchers noted.
Although the statistical models controlled for several lifestyle factors, other unmeasured variables could influence both sleep patterns and life expectancy.
Sleep duration alone does not capture other dimensions of sleep health, such as quality or regularity, which may also affect long-term outcomes, according to the study.
The authors emphasized that these findings highlight the importance of prioritizing sleep as a core pillar of health, on par with diet and exercise.
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"This research shows that we need to prioritize sleep at least as much as what we eat or how we exercise," McHill said. "Getting a good night’s sleep will improve how you feel, but also how long you live."
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The study was primarily conducted by graduate students in the Sleep, Chronobiology and Health Laboratory at OHSU’s School of Nursing.
The research was funded in part by the National Heart, Lung and Blood Institute of the National Institutes of Health, along with institutional support from OHSU.
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