Sleep Difficulties & Patterns Among Americans
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.