Effect of Inadequate Sleep on Frequent Mental Distress

Amanda Blackwelder, MPH; Mikhail Hoskins, MPH; Larissa Huber, PhD


Prev Chronic Dis. 2021;18(6):e61 

In This Article

Abstract and Introduction


Introduction: One-third of US adults report sleeping less than the recommended amount, and approximately 20% live with a mental illness. The objective of our study was to examine the association between inadequate sleep and frequent mental distress in a population-based sample of US adults.

Methods: We conducted a cross-sectional study by using 2018 Behavioral Risk Factor Surveillance System (BRFSS) data that included 273,695 US adults aged 18 to 64. Inadequate sleep was defined as 6 hours or less in a given night, and frequent mental distress was defined as self-reporting 14 days of mental health status as "not good" within the last month. We used weighted logistic regression to calculate odds ratios (ORs) and 95% CIs.

Results: Thirteen percent of study participants experienced inadequate sleep, and 14.1% experienced frequent mental distress. Participants who averaged 6 hours or less of sleep per night were about 2.5 times more likely to have frequent mental distress when controlling for confounders (OR, 2.52; 95% CI, 2.32–2.73) than those who slept more than 6 hours.

Conclusion: Inadequate sleep was associated with significantly increased odds of frequent mental distress. Our findings suggest that further research is necessary to evaluate the temporal relationship between inadequate sleep and frequent mental distress.


Poor mental health is common in the US. Nearly 1 in 5 US adults live with mental illness.[1] Furthermore, an estimated 50% of all Americans will be diagnosed with a mental illness or disorder at some point in their life.[1,2] Mental health illness includes many different conditions and symptoms, such as anxiety, depression, stress, and other psychological illnesses. Moderate and severe mental disorders that need psychological treatment require regular visits to a health care provider, thus lowering workplace productivity.[3] Furthermore, depression, schizophrenia, and bipolar disorder are risk factors for coronary heart disease, hypertension, diabetes, dyslipidemia, metabolic syndrome, obesity, stroke, and substance abuse disorders.[3,4] Depression and anxiety alone cost over $1 trillion annually for medications, outpatient and primary care visits, and inpatient care.[3,4]

The Centers for Disease Control and Prevention (CDC) and the American Academy of Sleep Medicine emphasize the importance of an adequate night's sleep, which is defined as 7 or more hours per night with no upper limit.[5,6] Anything less than this amount may lead to the development of various chronic diseases. More than one-third of the US population does not get adequate sleep.[5] The people that most often get inadequate sleep are Native Hawaiian/Pacific Islander people, non-Hispanic Black people, and multiracial people.[6] Those who most often get adequate sleep are married people and people with a college degree or more.

Studies have demonstrated an association between inadequate sleep and frequent mental distress,[7,8] and sleep deprivation causes substantial negative health outcomes.[4] The link between inadequate sleep and frequent mental distress has been viewed historically as a symptom–disease association with sleep inadequacies deriving from preexisting mental distress.[9] However, at least 1 study researched the opposite hypothesis, evaluating frequent mental distress leading to a lack of sleep.[10] These studies found that in certain populations, risk for inadequate sleep is increased if a person is experiencing depression or anxiety. Most current research on the potential association between inadequate sleep and mental distress focuses on a specifically defined group, such as college students, nurses, or people with diagnosed sleep disorders.[9,11,12] Furthermore, current research focuses primarily on diagnosed mental health disorders.[4,8] The purpose of our study was to examine the association between inadequate sleep and frequent mental distress in a diverse, population-based sample of adults aged 18 to 64.