Kentucky is one of the most sleep-deprived states; Appalachian Ky. is even more so, and that affects people's health and safety

Screenshot of interactive map; for the interactive version, with county-by-county figures, click here.

Kentucky is one of the leading sleep-deprived states, ranking fourth in the percentage of adults reporting that they get less than seven hours of sleep per day, 40.5 percent. So says the 2020 Behavioral Risk Factor Surveillance System survey, a continuing national poll by the Census Bureau. The U.S. rate was 34.8%.

Even fewer adults in Kentucky's Appalachian counties are getting enough sleep. CDC data from 2018 shows that between 40.6% to 49.1% of people living in the region reporting they get less than seven hours of sleep per day. McCreary County's 49.1% was the highest in the nation.

The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults sleep at least seven hours a night. 

The CDC reports that the percentage of adults who had trouble falling asleep most days or every day in the past 30 days was highest outside metropolitan areas (17.1%). Adults in nonmetro areas also had the highest rate for having trouble staying asleep (22.4%). 

Dr. Kay Miller Temple took a look at the impact of sleep on rural America's health and safety for The Rural Monitor, published by the Rural Health Information Hub. Rural doctors told her that while sleep problems presented as a primary concern for many of their patients, their trouble sleeping was often related to other conditions, both physical and mental. 

“Sleep also shows up as ‘incident to’ other presenting complaints,” Dr. Jennifer Brull, a recently retired family medicine physician from Plainville, Kansas, told Temple. “For example, when you’re working with a patient on addressing blood pressure that’s too high, or diabetes that’s poorly controlled, or mental health conditions like depression and anxiety, a sudden change in the stability of chronic conditions is often linked to sleep patterns.”

Talking about sleep is a great way to open the discussion about other sensitive topics, like substance use disorder and mental health, board-certified clinical psychologist Tess M. Kilwein, who operates a teletherapy practice with 75% of her patients located in rural areas of four states, told Temple. 

Dr. Lois Krahn, a psychiatrist, sleep medicine specialist and medical educator, told Temple that sleep deprivation can result in people being "really unhappy, irritable, reactive, and just overall miserable." She said people in rural areas might only get three hours of sleep during harvest time or if they do shift work.

One challenge for rural people who are sleep-deprived is that they have to drive longer distances in an unchanging landscape to do anything, and that often includes commuting long distances to do shift work, Brull told Temple.

“We know from the National Highway Traffic Administration that drowsy-driving crashes and fatalities are more common in rural areas,” Anne Wheaton, deputy associate director for Science in the Division of Population Health at the CDC, told Temple. 

One reason seniors in rural areas fall asleep so often is because they are bored or because they don't have any social interaction, Dr. Evin Jerkins told Temple. 

"If they live an hour out on a country road, there are no local activities to attend, so I find out when they’re most likely to fall asleep, and together we figure out a practical activity to slot into that time, like calling friends and family," said Jerkins. 

And an unexpected reason that is contributing to people getting less sleep is climate change, Kasha Patel reports for The Washington Post. 

Researcher Nick Obradovich, principal investigator at the Max Planck Institute for Human Development in Germany, and his colleagues found that "humans are already losing shut-eye in warm environments, especially at the beginning of the night. Models predict a solid sleep will further decrease as temperatures rise, especially in lower-income and elderly communities," Patel reports..

The study looked at 47,000 adults in 68 countries and found there were "notable change in sleep duration when nighttime temperatures rose above 50 degrees (10 degrees Celsius). On nights above 86 degrees, people slept about 14 minutes less on average," Patel writes.

This story has been fixed to reflect the correct publisher of The Rural Monitor.