Over half of Americans aren't sleeping enough, especially young women

Americans are not getting enough sleep, according to a new Gallup poll. In fact, it’s the first time since 2001 that a majority of adults (57%) say they need more sleep. With clinical research showing that 4 in 10 patients report sleep disturbances due to the COVID-19 pandemic, Gallup’s finding may come as no surprise.^[]

The poll found that only 42% of Americans are getting the sleep they need—a sharp drop from 2013 when 56% of Americans said they got enough sleep. As Gallup explains, “Americans’ perception that they aren’t getting enough sleep is borne out by the diminished number of hours of sleep they report getting per night.” The Centers for Disease Control and Prevention (CDC) recommends adults get a minimum of seven hours of sleep per night. However, the poll found that 20% of Americans are getting five hours or less (while only 26% are getting eight or more hours). These percentages have drastically changed over the decades. In 1942, only 3% of Americans got five hours or less, while 59% got eight or more hours of sleep.^[] The poll also found some notable differences in gender, with 36% of women (versus 48% of men) reporting that they get enough sleep. “Both figures represent significant declines from previous readings in 2013 and 2004 and are the lowest Gallup has measured for each group to date,” Gallup reports.^[]

Gallup says stress levels are influencing Americans’ sleep hygiene. “Over the past 30 years, the number of Americans who are stressed has been on a steady incline after a sharp drop in 2003. The most recent data show that nearly half of all Americans, 49%, report frequently experiencing stress, up 16 points over the past two decades and the highest in Gallup’s trend to date,” Gallup reports.^[] As Gallup reports, younger women are also markedly more stressed than both women and men over 50 as well as men ages 18-49.^[] Stress plays a bidirectional role in the prevalence of poor sleep hygiene, since stress leads to poor sleep and poor sleep leads to reduced ability to manage stress, explains Julia R. Blank, MD, board-certified family medicine physician at Providence Saint John’s Health Center in Santa Monica, CA. Dr. Blank believes a few issues are contributing to Americans’ stress levels. First, she says, the COVID-19 pandemic made remote work the norm. “I think working from home created an environment in which people were able to work at odd hours and be accessible pretty much all the time,” Dr. Blank says. “That created an expectation that because they could be accessible they would be accessible. But this hasn't changed since the pandemic.” Dr. Blank says that kind of work stress being present in the home has an undeniable impact on sleep. 

She says domestic duties are also contributing to poor sleep. “A lot of people of working age also have children or are taking care of parents—or both. The demands of caring for a family [are] not time-limited,” Dr. Blank says. She believes that a larger share of this type of burden falls on women, which is why there may be a discrepancy between the stats around men's and women’s sleep and stress. 

“Whether it's work that you’re being paid for or work you're not being paid for [at home], it has an impact on your schedule and your ability to go to and stay asleep,” Dr. Blank says. These issues also contribute to stress levels, which compounds the issue. 

Chester Wu, MD, who is double-board certified in psychiatry and sleep medicine, agrees with Dr. Blank’s sentiments. He also adds that hormones may be partially responsible for needing additional sleep. “Sex hormones themselves may modulate sleep. This is not well understood at the human level but in animals, it has been found that estradiol can modulate sleep and presumably does as well in humans,” Dr. Wu says. “This would make fluctuations in the menstrual cycle all the more relevant for sleep and especially menopause for women.”

How can clinicians help patients get better sleep?

Dr. Wu also says clinicians should know how sleep impacts patients' health. “Poor sleep hygiene’s negative effect on health/cognition is typically mediated by chronically poor sleep,” Dr. Wu says. In the long-term, chronic sleep loss (and sleep disorders) are linked to obesity, hypertension, diabetes, and risk of heart attack and stroke, he says. “It can trigger or worsen mood disorders like depression and anxiety…and impair vital cognitive functions including memory, concentration, decision-making, and problem-solving abilities,” he explains. 

Dr. Wu suggests clinicians should view sleep as one of their patients’ vital signs. “Sleep concerns are a widely under-identified issue, whether it's patients self-medicating with over-the-counter medications or alcohol, not realizing it is a concern that they should bring up to their clinician, or just clinicians not asking about it,” Dr. Wu says. 

Dr. Blank adds that clinicians should also help patients look at the variables that impact their sleep hygiene. “It merits looking into what’s keeping them awake or limiting their ability to fall and stay asleep,  including stimulants, alcohol, schedule, work/home, and stressors,” she says.

At bedtime, patients should be encouraged to create a healthy sleep environment. This includes, Dr. Blank says, turning off electronics an hour before bed, turning off extraneous noise and light, and settling down mentally (which may include journaling to get the thoughts ‘out.’