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If you have trouble sleeping, you are not alone. In a recent study based on information provided by 444,000 adults in all 50 states, the Centers for Disease Control has found Americans are just not getting enough sleep. While they recommend adults sleep at least seven hours per night, many states report nearly a third of their population is not reaching that amount.

“As a nation we are not getting enough sleep,” said Wayne Giles, director of Division of Population Health at the Centers for Disease Control.

The study was the first time that the Centers for Disease Control has conducted that compared sleep habits across all 50 states. Which state had the most trouble sleeping? Hawaii. Nearly half of the adults in Hawaii reported that they don’t get the required amount of sleep, which seems strange considering the relaxed lifestyle of the United States’ only island state.

A variety of health risks have been associated with not getting enough sleep. Many of them are associated with cardiovascular disease like heart disease and high blood pressure, but Alzheimer’s disease and kidney disease have also been linked to a lack of sleep. Sleep helps the body remove toxins and gives the brain time to relax and absorb experiences. It’s important for regulating blood sugar and controlling blood pressure.

While the study did not make any definitive conclusions on the reasons for the discrepancy between states, the data showed a correlation between sleep, obesity and smoking. Heavier people, in general, have a more difficult time sleeping, and smoking is thought to cause interruption in sleep patterns. For example, a 2013 study in the FASEB Journal found that smoking throws off the circadian rhythm, the body’s natural sleep/wake cycle that is tied to night and day.

The CDC found that a large number of the states where a higher percentage of the population does not get enough sleep were centered around the Appalachian Mountains and the Southeastern United States. These are regions with higher obesity rates and a greater number of smokers, but Delaware and Rhode Island were in the bottom part of the rankings.

According to the CDC’s ranking of states, South Dakota is the best place to get a good night of sleep. Nearly 72% of the residents reported that they achieved the required seven hours of sleep. People have speculated that the low unemployment rate in the state and a more structured lifestyle could be the reasons. The study reported that only 60% of unemployed people got enough sleep.

Ethnicity was also a possible factor in the results. The data showed that 67% of white Americans slept at least seven hours, but only 54% of Native Hawaiians/Pacific Islanders and only 54% of African American say they get enough sleep. The reasons for this difference were not apparent.

To get enough sleep, the CDC had several recommendations. They included getting some form of exercise during the day and having a work schedule that allows for a healthy sleep schedule. Also, people should seek medical advice if they experience sleep apnea, insomnia or other forms of sleep illness that make them have trouble sleeping.

“Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need,” Giles said.

Here is the complete list of states (and the District of Columbia) ranking from best night’s sleep to worst.

  • South Dakota
  • Colorado
  • Minnesota
  • Nebraska
  • Idaho
  • Montana
  • Utah
  • Kansas
  • Iowa
  • Vermont
  • Wyoming
  • Oregon
  • North Dakota
  • Washington
  • New Mexico
  • District of Columbia
  • Wisconsin
  • North Carolina
  • New Hampshire
  • Maine
  • Texas
  • Arizona
  • California
  • Missouri
  • Illinois
  • Massachusetts
  • Alaska
  • Connecticut
  • Oklahoma
  • Florida
  • Virginia
  • Nevada
  • Louisiana
  • Rhode Island
  • Mississippi
  • Tennessee
  • New Jersey
  • Arkansas
  • Pennsylvania
  • Delaware
  • Ohio
  • New York
  • West Virginia
  • Indiana
  • South Carolina
  • Georgia
  • Michigan
  • Alabama
  • Maryland
  • Kentucky
  • Hawaii
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