Although sleep is vital to our well-being, as many as 35.1% of American adults fail to get at least seven hours of sleep each night — the minimum recommended sleep time for adults. Beyond feeling tired and less productive, a lack of sleep has more far-reaching implications — mostly to our health.

Research shows that not getting enough rest each night is associated with numerous physical and mental health problems. A lack of sleep can also lead to accidents in the workplace, fatal crashes on the road, and poor performance at work. The Centers for Disease Control and Prevention (CDC) surveyed American adults to find how many hours of sleep they get each day, on average. While nationally 35.1% of adults are sleep deprived, the problem varies significantly across states. In South Dakota, 28.4% fail to get enough sleep each night, while in Hawaii, 43.9% are sleep deprived.

The CDC has linked insufficient sleep with a number preventable diseases and conditions. Sleep deprivation has been shown to lead to an increased risk of diabetes, high blood pressure, heart disease, and obesity. These conditions tend to be less common in states where a larger share of adults are getting sufficient sleep.

Click here to see the which state residents get the most and least sleep.

Of the 26 states where a larger than average share of adults are getting adequate sleep, only four have a larger share than average share of adults with heart disease. Additionally, of the 26 states with better than average sleep habits, only seven have a larger than average share of adults with diabetes. Conversely, in 17 of the 24 states where adults are getting less sleep than adults nationwide, heart disease and diabetes are more common than they are across the country.

In addition to all the physical problems that are related to a lack of adequate rest, mental health is also closely tied to sleep. In the vast majority of states where relatively few adults are getting enough sleep, adults also report feeling in poor mental well-being more often than the average American.

It is also important to look at what can cause a lack of sleep. Many outside factors can induce stress, and these factors indeed tend to be more prevalent in states with poor sleeping habits. Financial security, for example, is important for mental well-being, and gainful employment is often essential to maintaining overall well-being. Each of the 10 states with the highest share of adults getting sufficient sleep also have among the lowest unemployment rates in the country.

Just as stressors can lead to inadequate sleep, a lack of sleep can lead to stress and depression. Often, this is a vicious cycle where stress causes less sleep, which can lead to an unhealthy mental state, which can induce further stress and less sleep.

While sleep is important to personal health, sleep deprivation also poses more immediate, and perhaps more obvious, risks to individuals and communities. According to the National Sleep Foundation, sleepiness can impair an individual’s ability to drive, in the same manner as alcohol. “[S]leepiness slows reaction time, decreases awareness, [and] impairs judgement” — factors that can increase the risk of an accident. The National Highway Traffic Safety Administration reports that roughly 846 fatalities on America’s roadways each year are attributable to drowsy driving. Similarly, for those working in dangerous occupations, drowsiness can increase the risk of a fatality on the job.

In order to determine the states getting the most (and least) sleep, 24/7 Wall St. reviewed data from the CDC on the percentage of adults by state reporting insufficient sleep, defined as less than seven hours per night. Other data, including personal income per capita, cardiovascular deaths, and physical activity were compiled by the United Health Foundation. Data on roadway deaths by state came from the Insurance Institute for Highway Safety. States were ranked from the smallest share of adults reporting insufficient sleep to the largest share. Unemployment rates are from the most recent annual comparable period.

These are the states getting the most (and least) sleep.

1. South Dakota
> Pct. of adults getting insufficient sleep: 28.4%
> Avg. number of poor mental health days (per month): 2.7 (2nd lowest)
> Pct. of adults with heart disease: 4.2% (22nd highest)
> Pct. of adults who are physically active: 78.8% (15th highest)
> Personal income (per capita): $46,345 (21st highest)
> Unemployment rate: 3.4% (3rd lowest)

Only 28.4% of adults in South Dakota are sleep deprived, the lowest share of any state. Certain sleep disorders have been linked to increased risk of cardiovascular disease, and South Dakota also has a lower annual rate of cardiovascular deaths than the national rate, at the 233 per 100,000 state residents compared to 251 cardiovascular deaths for every 100,000 Americans.

2. Colorado
> Pct. of adults getting insufficient sleep: 28.5%
> Avg. number of poor mental health days (per month): 3.2 (11th lowest)
> Pct. of adults with heart disease: 3.0% (3rd lowest)
> Pct. of adults who are physically active: 83.6% (the highest)
> Personal income (per capita): $48,730 (14th highest)
> Unemployment rate: 5.0% (15th lowest)

Fewer than 29% of adults in Colorado report inadequate sleep. As is the case in most states where a relatively small share of adults is sleep deprived, incomes in Colorado tend to be higher than across the country.

3. Minnesota
> Pct. of adults getting insufficient sleep: 29.2%
> Avg. number of poor mental health days (per month): 2.8 (5th lowest)
> Pct. of adults with heart disease: 3.5% (7th lowest)
> Pct. of adults who are physically active: 79.8% (13th highest)
>Personal income (per capita): $48,711 (15th highest)
> Unemployment rate: 4.1% (6th lowest)

More adults are getting sufficient sleep in Minnesota than in every other state except for Colorado and South Dakota. Sleep is linked to a number of other healthy behaviors and outcomes, and Minnesota residents are the least likely in the country to die from preventable causes.

4. Nebraska
> Pct. of adults getting insufficient sleep: 30.4%
> Avg. number of poor mental health days (per month): 2.8 (5th lowest)
> Pct. of adults with heart disease: 3.9% (16th lowest)
> Pct. of adults who are physically active: 78.7% (18th highest)
> Personal income (per capita): $47,073 (19th highest)
> Unemployment rate: 3.3% (2nd lowest)

Nearly 70% of adults in Nebraska are getting enough sleep. As is the case in the majority of states with relatively well rested residents, unemployment is low in Nebraska. Only 3.3% of the workforce is out a job, the second lowest unemployment rate in the country.

5. Idaho
> Pct. of adults getting insufficient sleep: 30.6%
> Avg. number of poor mental health days (per month): 3.2 (11th lowest)
> Pct. of adults with heart disease: 3.4% (6th lowest)
> Pct. of adults who are physically active: 81.3% (5th highest)
> Personal income (per capita): $37,533 (5th lowest)
> Unemployment rate: 4.8% (14th lowest)

Adults in Idaho are among the least likely to be sleep deprived. While incomes tend to be higher in states where a large share of adults are getting enough sleep, Idaho is a notable exception. Per capita income in Idaho is only $37,533, considerably less than the $46,129 the typical American earns.

6. Montana
> Pct. of adults getting insufficient sleep: 30.7%
> Avg. number of poor mental health days (per month): 3.3 (15th lowest)
> Pct. of adults with heart disease: 3.6% (10th lowest)
> Pct. of adults who are physically active: 80.4% (9th highest)
> Personal income (per capita): $40,601 (16th lowest)
> Unemployment rate: 4.7% (13th lowest)

Montana residents are not only more likely to get adequate sleep, but also adequate exercise. Only 19.6% of adults in the state are physically inactive, a smaller share than the 22.6% of American adults who do not participate in physical activity in their free time.

7. Utah
> Pct. of adults getting insufficient sleep: 30.8%
> Avg. number of poor mental health days (per month): 3.5 (21st lowest)
> Pct. of adults with heart disease: 2.5% (2nd lowest)
> Pct. of adults who are physically active: 83.2% (3rd highest)
> Personal income (per capita): $37,766 (9th lowest)
> Unemployment rate: 3.8% (4th lowest)

In Utah, 30.8% of adults are sleep deprived compared to the 35.1% of American adults who sleep deprived. Utah adults are also more likely to exhibit other healthy behaviors. For example, only 11.4% of adults in the state binge drink, the third smallest share of any state in the country.

8. Kansas
> Pct. of adults getting insufficient sleep: 30.9%
> Avg. number of poor mental health days (per month): 3.0 (8th lowest)
> Pct. of adults with heart disease: 4.2% (22nd highest)
> Pct. of adults who are physically active: 76.2% (18th lowest)
> Personal income (per capita): $45,546 (23rd highest)
> Unemployment rate: 4.5% (12th lowest)

Slightly less than 31% of adults in Kansas report getting insufficient sleep, one of the lowest shares in the country. Stress can cause insomnia. The Kansas economy is relatively healthy, which may help reduce stress among state adults — and perhaps also help them sleep better.

9. Iowa
> Pct. of adults getting insufficient sleep: 31.0%
> Avg. number of poor mental health days (per month): 3.0 (8th lowest)
> Pct. of adults with heart disease: 4.1% (24th lowest)
> Pct. of adults who are physically active: 77.4% (25th highest)
> Personal income (per capita): $45,115 (25th highest)
> Unemployment rate: 4.4% (10th lowest)

In Iowa, 69% of adults get enough sleep, a higher share than in the vast majority of states.
According to the CDC, insufficient sleep can hinder cognitive performance. Furthermore, insomnia is often a sign of depression. Iowans report feeling in poor mental health only three days a month, one of the lowest shares in the country.

10. Vermont
> Pct. of adults getting insufficient sleep: 31.0%
> Avg. number of poor mental health days (per month): 3.4 (18th lowest)
> Pct. of adults with heart disease: 4.1% (24th lowest)
> Pct. of adults who are physically active: 81.0% (6th highest)
> Personal income (per capita): $47,330 (18th highest)
> Unemployment rate: 4.1% (6th lowest)

Certain healthy behaviors such as getting adequate sleep often accompany other healthy behaviors. Not only are Vermonters among the most likely to get enough sleep, but they are also among the most likely to be in very good health.

11. Wyoming
> Pct. of adults getting insufficient sleep: 31.3%
> Avg. number of poor mental health days (per month): 3.3 (15th lowest)
> Pct. of adults with heart disease: 4.0% (21st lowest)
> Pct. of adults who are physically active: 77.9% (22nd highest)
> Personal income (per capita): $52,826 (9th highest)
> Unemployment rate: 4.3% (8th lowest)

A lack of sufficient sleep is linked to a greater prevalence of several common medical conditions. Wyoming, which has one of the lower shares of adults who get insufficient sleep, also has among the lowest share of conditions such as hypertension and diabetes among adults.

12. Oregon
> Pct. of adults getting insufficient sleep: 31.7%
> Avg. number of poor mental health days (per month): 4.1 (8th highest)
> Pct. of adults with heart disease: 4.0% (21st lowest)
> Pct. of adults who are physically active: 83.5% (2nd highest)
> Personal income (per capita): $41,681 (19th lowest)
> Unemployment rate: 6.9% (8th highest)

Not getting enough sleep can impair cognitive performance and lead to serious, often fatal accidents at work. In Oregon, a state where adults are more likely than the typical American to get adequate sleep, there are 3.3 occupational fatalities per 100,000 workers annually, one of the smallest such shares in the country.

13. North Dakota
> Pct. of adults getting insufficient sleep: 31.8%
> Avg. number of poor mental health days (per month): 2.8 (5th lowest)
> Pct. of adults with heart disease: 4.0% (21st lowest)
> Pct. of adults who are physically active: 78.7% (18th highest)
> Personal income (per capita): $54,951 (6th highest)
> Unemployment rate: 2.8% (the lowest)

Adults in North Dakota are among the most likely in the country to get a sufficient amount of sleep. Getting fewer than seven hours of sleep per night can increase the risk of stroke among adults. In North Dakota, only 2.4% of adults report having had a stroke, one of the smallest shares in the country.

14. Washington
> Pct. of adults getting insufficient sleep: 31.8%
> Avg. number of poor mental health days (per month): 3.7 (20th highest)
> Pct. of adults with heart disease: 3.6% (10th lowest)
> Pct. of adults who are physically active: 81.9% (4th highest)
> Personal income (per capita): $49,583 (12th highest)
> Unemployment rate: 6.2% (22nd highest)

Drowsy driving can be just as fatal as drunk driving. In Washington, a state where a relatively large share of the adult population is well rested, fatal car accidents are also relatively uncommon. There are about 6.5 deaths on the road for every 100,000 state residents annually, considerably less than the national rate of 10.2 roadway deaths per 100,000 people.

15. New Mexico
> Pct. of adults getting insufficient sleep: 32.0%
> Avg. number of poor mental health days (per month): 3.9 (14th highest)
> Pct. of adults with heart disease: 3.9% (16th lowest)
> Pct. of adults who are physically active: 76.7% (24th lowest)
> Personal income (per capita): $37,605 (6th lowest)
> Unemployment rate: 6.5% (15th highest)

While New Mexico ranks below the vast majority of states in a number of health-related measures, inadequate sleep is not one of them. Only 32% of adults in the state do not get enough sleep, a lower share than the roughly 35% of American adults who are sleep deprived.

16. Wisconsin
> Pct. of adults getting insufficient sleep: 32.2%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 3.7% (14th lowest)
> Pct. of adults who are physically active: 78.8% (15th highest)
> Personal income (per capita): $44,585 (25th lowest)
> Unemployment rate: 5.5% (18th lowest)

While it ranks worse than a number of states, Wisconsin still has a smaller share of adults getting enough sleep every night compared to the nation as a whole. Getting sufficient rest is tied to reducing the risk of a number of diseases, and indeed the state has relatively low rates of heart disease, heart attack, and diabetes.

17. North Carolina
Pct. of adults getting insufficient sleep: 32.4%
Avg. number of poor mental health days (per month): 3.6 (22nd highest)
Pct. of adults with heart disease: 5.0% (12th highest)
Pct. of adults who are physically active: 76.8% (25th lowest)
Personal income (per capita): $39,646 (13th lowest)
Unemployment rate: 6.1% (23rd highest)

Adults in North Carolina are more likely to be well rested than adults across America. However, they do not fare as well as their peers nationwide in several other healthy behaviors. A slightly higher share of adults in the state report a smoking habit and infrequent physical activity compared to the national rates.

18. New Hampshire
> Pct. of adults getting insufficient sleep: 32.5%
> Avg. number of poor mental health days (per month): 3.5 (21st lowest)
> Pct. of adults with heart disease: 4.2% (22nd highest)
> Pct. of adults who are physically active: 80.7% (8th highest)
> Personal income (per capita): $53,149 (7th highest)
> Unemployment rate: 4.3% (8th lowest)

A higher than average share of New Hampshire adults gets enough rest each night. The state has one of the lowest unemployment, poverty, and violent crime rates, all of which may reduce stress. A high degree of stress can cause difficulty sleeping, and the relative economic security and safety may help lower overall stress and therefore improve sleep among state adults.

19. Maine
> Pct. of adults getting insufficient sleep: 32.9%
> Avg. number of poor mental health days (per month): 3.8 (18th highest)
> Pct. of adults with heart disease: 5.4% (7th highest)
> Pct. of adults who are physically active: 80.3% (11th highest)
> Personal income (per capita): $42,071 (20th lowest)
> Unemployment rate: 5.7% (21st lowest)

Along with getting enough sleep, regular exercise is a crucial component of good health. In Maine, Less than 33% of adults are sleep deprived and less than 20% are physically inactive, each lower than the 35% and 23% national shares, respectively. Both factors likely contribute to the lower obesity rate among Maine adults compared to the rate among American adults.

20. Texas
> Pct. of adults getting insufficient sleep: 33.0%
> Avg. number of poor mental health days (per month): 3.0 (8th lowest)
> Pct. of adults with heart disease: 3.7% (14th lowest)
> Pct. of adults who are physically active: 72.4% (8th lowest)
> Personal income (per capita): $45,426 (24th highest)
> Unemployment rate: 5.1% (16th lowest)

A lack of sleep has been tied to a variety of negative health outcomes. Texas, which ranks just slightly better than the national average, has an above average obesity rate but a below average heart disease rate.

21. Arizona
> Pct. of adults getting insufficient sleep: 33.3%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 4.0% (21st lowest)
> Pct. of adults who are physically active: 78.8% (15th highest)
> Personal income (per capita): $37,895 (10th lowest)
> Unemployment rate: 6.9% (8th highest)

Exactly one-third of adults in Arizona are sleep deprived, a slightly smaller share than the 35.1% of American adults who do not get enough sleep. While most states with relatively well-rested adults have healthy economies, Arizona is an exception. The unemployment rate in the state is 6.9% compared to the 6.2% national unemployment rate.

22. California
> Pct. of adults getting insufficient sleep: 33.6%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 3.7% (14th lowest)
> Pct. of adults who are physically active: 78.3% (21st highest)
> Personal income (per capita): $50,109 (10th highest)
> Unemployment rate: 7.5% (4th highest)

Californians appear to be relatively health conscious. Not only are they more likely to get an adequate amount of sleep than most Americans, but they also eat more fruits and vegetables on average than residents of any other state.

23. Missouri
> Pct. of adults getting insufficient sleep: 34.0%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 4.8% (13th highest)
> Pct. of adults who are physically active: 75.0% (15th lowest)
> Personal income (per capita): $41,613 (18th lowest)
> Unemployment rate: 6.1% (23rd highest)

Adults in Missouri are only slightly more likely than American adults to get enough sleep. By other health measures, Missouri lags behind the nation. Adults in the state are slightly more likely to be obese, have a smoking habit, and be physically inactive than the typical American adult.

24. Illinois
> Pct. of adults getting insufficient sleep: 34.4%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 3.6% (10th lowest)
> Pct. of adults who are physically active: 76.1% (17th lowest)
> Personal income (per capita): $48,120 (16th highest)
> Unemployment rate: 7.1% (7th highest)

A lack of sleep can lead to poor mental health and stress. Illinois, which has a slightly below average rate of adults getting sufficient sleep, also fares slightly worse than the nation in the average number of poor mental health days among adults.

25. Massachusetts
> Pct. of adults getting insufficient sleep: 34.5%
> Avg. number of poor mental health days (per month): 3.9 (14th highest)
> Pct. of adults with heart disease: 4.3% (21st highest)
> Pct. of adults who are physically active: 79.9% (12th highest)
> Personal income (per capita): $59,182 (2nd highest)
> Unemployment rate: 5.8% (24th lowest)

Sleep deprivation among adults in Massachusetts is nearly as common as it is among American adults. Stress resulting from financial insecurity is less likely to contribute to sleep deprivation in the Bay State as the unemployment rate is lower in Massachusetts than it is in the country as a whole. Also, at $59,182, personal income per capita in Massachusetts is the second highest of any state in the country.

26. Alaska
> Pct. of adults getting insufficient sleep: 35.0%
> Avg. number of poor mental health days (per month): 3.1 (9th lowest)
> Pct. of adults with heart disease: 2.4% (the lowest)
> Pct. of adults who are physically active: 80.8% (7th highest)
> Personal income (per capita): $52,901 (8th highest)
> Unemployment rate: 6.8% (10th highest)

Some 35% of adults in Alaska are sleep deprived, inline with corresponding 35.1% national rate. Cardiovascular disease is linked to insufficient sleep, and despite a close correlation to the national insufficient sleep rate, deaths due to cardiovascular disease are far less common in Alaska than they are across the country. There are 215 cardiovascular deaths per 100,000 people annually in Alaska compared to the national rate of 251 deaths per 100,000 people.

27. Connecticut
> Pct. of adults getting insufficient sleep: 35.2%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 3.7% (14th lowest)
> Pct. of adults who are physically active: 79.4% (14th highest)
> Personal income (per capita): $62,467 (the highest)
> Unemployment rate: 6.6% (13th highest)

Connecticut’s adults are slightly less likely than the typical American to be getting enough sleep. The state has a relatively high unemployment rate, and the associated stress of those jobless adults may be a factor contributing to some adults’ sleeping difficulties.

28. Oklahoma
> Pct. of adults getting insufficient sleep: 35.7%
> Avg. number of poor mental health days (per month): 4.1 (8th highest)
> Pct. of adults with heart disease: 5.4% (7th highest)
> Pct. of adults who are physically active: 71.7% (5th lowest)
> Personal income (per capita): $43,138 (24th lowest)
> Unemployment rate: 4.5% (12th lowest)

A slightly larger share of adults in Oklahoma are sleep deprived than adults across the country. Insufficient sleep is linked to obesity, and Oklahoma’s obesity rate of 33.0% is considerably higher than the national rate of 29.6%.

29. Florida
> Pct. of adults getting insufficient sleep: 35.8%
> Avg. number of poor mental health days (per month): 3.8 (18th highest)
> Pct. of adults with heart disease: 5.4% (7th highest)
> Pct. of adults who are physically active: 76.3% (19th lowest)
> Personal income (per capita): $42,645 (23rd lowest)
> Unemployment rate: 6.3% (20th highest)

Adults who do not get enough sleep are more prone to certain diseases, such as diabetes. In Florida, sleep deprivation is slightly more common that it is across the country. Correspondingly, the 11.2% share of adults in the state with diabetes is slightly higher than the 10.0% national rate.

30. Virginia
> Pct. of adults getting insufficient sleep: 36.0%
> Avg. number of poor mental health days (per month): 3.3 (15th lowest)
> Pct. of adults with heart disease: 4.0% (21st lowest)
> Pct. of adults who are physically active: 76.5% (21st lowest)
> Personal income (per capita): $49,710 (11th highest)
> Unemployment rate: 5.2% (17th lowest)

A disproportionate share of Virginia adults are sleep deprived. However, the state actually compares favorably to the country in many measures associated with adequate sleep. State residents have relatively good mental health, high income, and are less likely to be unemployed.

31. Nevada
> Pct. of adults getting insufficient sleep: 36.2%
> Avg. number of poor mental health days (per month): 3.4 (18th lowest)
> Pct. of adults with heart disease: 4.7% (17th highest)
> Pct. of adults who are physically active: 77.5% (23rd highest)
> Personal income (per capita): $40,077 (14th lowest)
> Unemployment rate: 7.8% (the highest)

One likely health effect of Nevada’s nation-leading 7.8% unemployment rate is stress. Stress is linked to insomnia and, perhaps not surprisingly, adults in Nevada are less likely than most Americans to get enough sleep.

32. Louisiana
> Pct. of adults getting insufficient sleep: 36.3%
> Avg. number of poor mental health days (per month): 3.9 (14th highest)
> Pct. of adults with heart disease: 6.2% (2nd highest)
> Pct. of adults who are physically active: 70.5% (3rd lowest)
> Personal income (per capita): $42,287 (21st lowest)
> Unemployment rate: 6.4% (18th highest)

Louisiana’s adults are more likely get insufficient sleep, but it is actually surprising the state does not rank lower on this list. Louisiana has among the worst rates of many factors that could lead to poor sleep, including low physical activity and high poverty.

33. Rhode Island
> Pct. of adults getting insufficient sleep: 36.7%
> Avg. number of poor mental health days (per month): 3.6 (22nd highest)
> Pct. of adults with heart disease: 4.2% (22nd highest)
> Pct. of adults who are physically active: 77.5% (23rd highest)
> Personal income (per capita): $48,838 (13th highest)
> Unemployment rate: 7.7% (3rd highest)

As in many states where a relatively large share of adults are sleep deprived, the Rhode Island economy is hurting. The 7.7% unemployment rate is one of the highest in the nation and considerably higher than the 6.2% national annual unemployment rate.

34. Mississippi
> Pct. of adults getting insufficient sleep: 37.0%
> Avg. number of poor mental health days (per month): 4.2 (6th highest)
> Pct. of adults with heart disease: 4.7% (17th highest)
> Pct. of adults who are physically active: 68.4% (the lowest)
> Personal income (per capita): $34,333 (the lowest)
> Unemployment rate: 7.8% (the highest)

Sleep deprivation is linked to several negative health outcomes and often correlates with some economic measures. Adults in Mississippi are more likely to be sleep deprived than most Americans — and Mississippi has the highest rate of physical inactivity, cardiovascular death, as well as one of the highest obesity rates in the nation. Furthermore, the 7.8% unemployment rate is the highest in the country.

35. Tennessee
> Pct. of adults getting insufficient sleep: 37.1%
> Avg. number of poor mental health days (per month): 4.8 (the highest)
> Pct. of adults with heart disease: 5.6% (5th highest)
> Pct. of adults who are physically active: 73.2% (9th lowest)
> Personal income (per capita): $40,654 (17th lowest)
> Unemployment rate: 6.7% (12th highest)

A lack of sleep is tied to a variety of poor health outcomes. In Tennessee, where a greater share of adults are failing to get sufficient sleep than the share of American adults overall, many of these poor health outcomes are common. The state has among the highest rates of hypertension, diabetes, and heart attack.

36. New Jersey
> Pct. of adults getting insufficient sleep: 37.2%
> Avg. number of poor mental health days (per month): 3.4 (18th lowest)
> Pct. of adults with heart disease: 4.4% (20th highest)
> Pct. of adults who are physically active: 76.7% (24th lowest)
> Personal income (per capita): $56,807 (3rd highest)
> Unemployment rate: 6.6% (13th highest)

There is evidence to suggest that stress can lead to a lack of sleep. However, despite the fact that New Jersey’s residents are less likely to get a good night’s rest, many of the economic conditions that can contribute to stress are not present in the state. The state has relatively low poverty and one of the highest personal incomes per capita in the country.

37. Arkansas
> Pct. of adults getting insufficient sleep: 37.4%
> Avg. number of poor mental health days (per month): 4.4 (5th highest)
> Pct. of adults with heart disease: 6.2% (2nd highest)
> Pct. of adults who are physically active: 69.3% (2nd lowest)
> Personal income (per capita): $37,751 (8th lowest)
> Unemployment rate: 6.1% (23rd highest)

While the relationship is complicated, many of the leading causes of death, including diabetes, heart disease, stroke, and high blood pressure, are tied to a lack of sleep. In Arkansas, where 37.4% of adults fail to get enough sleep each night, residents are much more likely to suffer from all of these health problems.

38. Pennsylvania
> Pct. of adults getting insufficient sleep: 37.5%
> Avg. number of poor mental health days (per month): 3.9 (14th highest)
> Pct. of adults with heart disease: 5.1% (11th highest)
> Pct. of adults who are physically active: 76.7% (24th lowest)
> Personal income (per capita): $47,727 (17th highest)
> Unemployment rate: 5.8% (24th lowest)

In Pennsylvania, 37.5% of adults do not get enough sleep, more than the corresponding 35.1% national rate. Just as adults in the state are more likely to be sleep deprived, they are also slightly more likely to be obese and not partake in physical activity compared to their counterparts across the country.

39. Delaware
> Pct. of adults getting insufficient sleep: 37.6%
> Avg. number of poor mental health days (per month): 3.5 (21st lowest)
> Pct. of adults with heart disease: 4.8% (13th highest)
> Pct. of adults who are physically active: 75.1% (16th lowest)
> Personal income (per capita): $45,942 (22nd highest)
> Unemployment rate: 5.7% (21st lowest)

Mental health and stress can cause a lack of sleep. But while Delaware adults are more likely to get insufficient sleep than adults in most states, the state has relatively good mental health among adults. The state also has low rates of stressors such as unemployment and uninsurance.

40. Ohio
> Pct. of adults getting insufficient sleep: 37.9%
> Avg. number of poor mental health days (per month): 4.1 (8th highest)
> Pct. of adults with heart disease: 4.8% (13th highest)
> Pct. of adults who are physically active: 75.0% (15th lowest)
> Personal income (per capita): $42,571 (22nd lowest)
> Unemployment rate: 5.7% (21st lowest)

Sleep deprivation is more common among adults in Ohio than it is in the majority of other states. Getting less than the recommended amount of sleep has been linked to depression and impaired cognitive ability. Adults in Ohio report feeling mentally unwell an average of 4.1 days per month, more than in all but a handful of states.

41. New York
> Pct. of adults getting insufficient sleep: 38.4%
> Avg. number of poor mental health days (per month): 3.7 (20th highest)
> Pct. of adults with heart disease: 4.2% (22nd highest)
> Pct. of adults who are physically active: 74.1% (11th lowest)
> Personal income (per capita): $56,231 (4th highest)
> Unemployment rate: 6.3% (20th highest)

Sleep and health appear to be closely tied, and populations lacking sleep also tend to have higher rates of life-threatening problems, including obesity and strokes. New York has a relatively low rate of both, however, despite having one of the least -rested adult populations.

42. West Virginia
> Pct. of adults getting insufficient sleep: 38.4%
> Avg. number of poor mental health days (per month): 4.6 (2nd highest)
> Pct. of adults with heart disease: 7.8% (the highest)
> Pct. of adults who are physically active: 71.3% (4th lowest)
> Personal income (per capita): $36,644 (2nd lowest)
> Unemployment rate: 6.5% (15th highest)

Sleep deprivation is linked to a number of diseases and conditions that can lead to premature death. In West Virginia, 38.4% of adults do not get enough sleep, one of the highest shares in the country. The state also has the largest share of adults with heart disease, high blood pressure, and diabetes.

43. Indiana
> Pct. of adults getting insufficient sleep: 38.5%
> Avg. number of poor mental health days (per month): 4.1 (8th highest)
> Pct. of adults with heart disease: 4.6% (19th highest)
> Pct. of adults who are physically active: 73.9% (10th lowest)
> Personal income (per capita): $39,433 (12th lowest)
> Unemployment rate: 6.0% (25th lowest)

Poor mental health is tied to stress, and stress can cause sleep issues. In Indiana, where 38.5% of adults do not get enough rest, residents report being in poor mental health more often than the typical American.

44. South Carolina
> Pct. of adults getting insufficient sleep: 38.5%
> Avg. number of poor mental health days (per month): 4.2 (6th highest)
> Pct. of adults with heart disease: 4.8% (13th highest)
> Pct. of adults who are physically active: 74.7% (13th lowest)
> Personal income (per capita): $36,934 (3rd lowest)
> Unemployment rate: 6.4% (18th highest)

Certain sleep disorders are linked to an increased risk of cardiovascular disease. In South Carolina, home to one of the most sleep deprived adult populations in the country, there are roughly 272 cardiovascular deaths per 100,000 annually, considerably higher than the national rate of 251 deaths per 100,000 each year.

45. Georgia
> Pct. of adults getting insufficient sleep: 38.7%
> Avg. number of poor mental health days (per month): 4.0 (13th highest)
> Pct. of adults with heart disease: 4.1% (24th lowest)
> Pct. of adults who are physically active: 76.4% (20th lowest)
> Personal income (per capita): $39,097 (11th lowest)
> Unemployment rate: 7.2% (6th highest)

Unemployment and underemployment can be a major stress inducer, and stress is a common cause of insomnia. In Georgia, a state with a 7.2% unemployment and 13.3% underemployment rate, nearly 39% of adults are sleep deprived — each a considerably higher share than the corresponding national figure.

46. Michigan
> Pct. of adults getting insufficient sleep: 38.7%
> Avg. number of poor mental health days (per month): 4.1 (8th highest)
> Pct. of adults with heart disease: 5.4% (7th highest)
> Pct. of adults who are physically active: 74.5% (12th lowest)
> Personal income (per capita): $40,556 (15th lowest)
> Unemployment rate: 7.3% (5th highest)

An increased risk of heart disease is closely linked to sleep deprivation. In Michigan, one of the most sleep deprived states in the country, 5.4% of adults have heart disease, a larger share than in all but a handful of other states.

47. Alabama
> Pct. of adults getting insufficient sleep: 38.8%
> Avg. number of poor mental health days (per month): 4.6 (2nd highest)
> Pct. of adults with heart disease: 5.6% (5th highest)
> Pct. of adults who are physically active: 72.4% (8th lowest)
> Personal income (per capita): $37,493 (4th lowest)
> Unemployment rate: 6.8% (10th highest)

In few states is the relationship between a lack of sleep and poor health outcomes more apparent. Alabama has one of worst rates of adequate sleep among adults in the country, and it is also among the worst five in the country in many health problems commonly associated with insufficient sleep, including high blood pressure, heart disease, and stroke.

48. Maryland
> Pct. of adults getting insufficient sleep: 38.9%
> Avg. number of poor mental health days (per month): 3.3 (15th lowest)
> Pct. of adults with heart disease: 3.2% (4th lowest)
> Pct. of adults who are physically active: 78.6% (20th highest)
> Personal income (per capita): $55,143 (5th highest)
> Unemployment rate: 5.8% (24th lowest)

Despite having one of the highest shares of adults who do not get sufficient sleep, Maryland fares much better than most other states in health conditions that can be induced by inadequate sleep. Only 3.2% of adults have heart disease, and 3.1% of adults have reported suffering a heart attack, each one of the lowest shares in the country.

49. Kentucky
> Pct. of adults getting insufficient sleep: 39.7%
> Avg. number of poor mental health days (per month): 4.5 (4th highest)
> Pct. of adults with heart disease: 6.0% (4th highest)
> Pct. of adults who are physically active: 71.8% (6th lowest)
> Personal income (per capita): $37,654 (7th lowest)
> Unemployment rate: 6.5% (15th highest)

Nearly 40% of Kentucky’s population does not get enough sleep every night. This may help explain why the state has extremely high rates of nearly every common life-threatening condition associated with a lack of sleep, including heart disease, high blood pressure, diabetes, and heart attacks.

50. Hawaii
> Pct. of adults getting insufficient sleep: 43.9%
> Avg. number of poor mental health days (per month): 2.7 (2nd lowest)
> Pct. of adults with heart disease: 3.4% (6th lowest)
> Pct. of adults who are physically active: 80.4% (9th highest)
> Personal income (per capita): $46,396 (20th highest)
> Unemployment rate: 4.4% (10th lowest)

Nearly 44% of adults in Hawaii do not get adequate sleep, far and away the highest share in the country. Despite pervasive unhealthy sleep patterns, Hawaiians do relatively well in several related health measures. The link between cardiovascular health and sleep is well established, yet only 3.1% of adults in the state report having had a heart attack, one of the smallest shares in the country. Also, there are only 203 cardiovascular deaths per 100,000 people annually compared to the national rate of 251 deaths per 100,000 people.

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