Sarah has covered news topics for digital and print publications. She holds a degree in broadcast journalism from the University of Nevada.
Sleep is an influential factor for optimizing our well-being, and yet many people still struggle with this element of health. Almost half of all Americans report daytime sleepiness, and insufficient sleep (less than 7 hours per night) is associated with health of the cardiovascular, immune, and nervous systems.
Some of these associations suggest increased risk of obesity, anxiety, depression, and diabetes. Kristen Knutson, Ph.D., professor of neurology at Northwestern University, and sleep expert, says that “sleep has such wide-ranging effects on health it should be considered part of a healthy lifestyle, along with diet and exercise.”
To investigate, Sleep Foundation partnered with Sleep Cycle — a global leader in sleep tracking app technology — and the two identified a unique opportunity to study the state of sleep across the United States.
Sleep Cycle’s innovative technology — which captures a variety of sleep data, voluntarily and anonymously provided by app users — combined with health metric data from the Center for Disease Control (CDC) and U.S. Census, have suggested the best and worst cities in the U.S. for sleep.
This analysis helps show that our physical, mental, and sleep health have multi-directional effects on one another. When we see that each of these factors influences the others, we are poised to prioritize them all in protecting our overall well-being.
This analysis helps show that our physical, mental, and sleep health have multi-directional effects on one another. When we see that each of these factors influences the others, we are poised to prioritize them all in protecting our overall well-being.
The state of sleep in the United States is more than just that — it may also give insight to our overall health.
While every city in America sleeps differently, this opportunity allowed Sleep Foundation to identify patterns and commonalities between a population’s sleep habits and other health factors. Dr. Wendy Troxel, Senior Behavioral Scientist at the RAND Corporation and sleep expert, notes that “your zip code affects your overall health and well-being — including your sleep health — as much as your genetic code.”
Sleep Cycle data is compiled using voluntarily and anonymously shared user information, which offers unique insight into sleep quality, not just sleep duration. Sleep Cycle’s patented snore detection technology can capture snore data, including how closely snoring is related to restless movement (one of multiple indicators of overall sleep health).
For this analysis, health-related data was extracted from the CDC, and U.S. Census to include a risk assessment of each city’s propensity for obesity, diabetes, and mental health concerns. It also included population information on leisure time, health insurance, and medical and dental check-ups in the past year. Considering these other health factors along with sleep data provided a unique perspective on each city.
Finally, the combined data from Sleep Cycle, the CDC, and U.S. Census was then analyzed to create a sleep score for each city. The overall sleep score each city earned was based on three metrics:
By directly comparing the best city and worst city for sleep in the U.S., Sleep Foundation gleaned insights about the relationship of our physical, mental, and sleep health.
Being active during rest and leisure time is important in maintaining physical health. When using leisure time to be active, these behaviors can help mitigate risk for chronic diseases like obesity and diabetes, and can positively impact our physical health, mental health, and sleep health.
Physical activity and sleep both impact our overall health, and data suggests a correlation between the two. A good night’s sleep provides you with enough energy to incorporate physical activity into your day, and physical activity can help you sleep.
Type 2 Diabetes can lead to sleep problems such as poor sleep quality and insomnia. For example, a study found that higher blood sugar levels can contribute to poorer sleep, in both people with diabetes and those who are pre-diabetic. The relationship between sleep and diabetes can impact our overall health. “Research studies have also shown that inadequate sleep could increase the risk of developing diabetes. Improving sleep health could reduce the risk,” Knutson says.
Obesity can impact your sleep. Specifically, it can contribute to insomnia, sleep apnea, and other trouble sleeping. Evidence also suggests an association with daytime sleepiness, even in those who report sleeping through the night. Such a connection can be related to a change in metabolism or sleep-wake cycles in a way that negatively affects sleep quality.
While having health insurance might not immediately seem directly connected to sleep health, this factor could indicate a correlation to a person’s level of sleep quality. Having health insurance may increase the likelihood that a person will access regular, preventive health care and appointments to monitor health conditions that can impact sleep. As physical, mental, and sleep health affect one another, such findings align with Seattle earning the top spot on the list, while Corpus Christi ranks lowest.
While a slightly higher percentage of people per capita in Corpus Christi accessed a doctor check-up in the past year than in Seattle, almost twice as many people per capita in Seattle report having a dental check-up in the last year.
Accessing regular dental care may be an important step in identifying sleep apnea and other disorders that can impact a person’s sleep health. In fact, the American Dental Association has a formal policy to include screenings for sleep-related breathing disorders during dental exams.
Cities with populations of 250,000 and greater were considered in the data analysis for the list. While many of these cities are located in the west, cities on this list are located throughout the nation.
#1 Overall sleep score: 71.16
The West ranks best in all categories, with the exception of having health insurance and having visited the doctor or dentist in the past year; however, the region’s overall wins in other categories compensate for these lower percentages. The multi-directional web of influential factors is at play: When combining lower risk for some chronic health conditions, longest sleep duration, and best sleep quality and snore score, the West wins.
#2 Overall sleep score: 70.78
The Midwest ranks second in factors including sleep quality, percentage of people who sleep seven or more hours per night, the percentage of people who report having leisure time, the percentage of people with no diabetes and mental health risks. This region also scores highest per capita for people with health insurance and who visited the dentist in the last year.
#3 Overall sleep score: 69.98
While this region scores well in the preventive care measures like doctor and dental check-ups as well as the percentage of people with health insurance, the Northeast ranks second lowest because going to the doctor and having health insurance aren’t the only elements that matter. The fact that the region ranks second lowest sleep quality rating as well as sleep duration suggests that measures to protect and preserve sleep are critical practices that one needs to actively participate in. Additionally, the Northeast ranks second lowest in its access to leisure time, and the second highest in diabetes and mental health risks. These factors can impede the ability to achieve a good night’s rest, which can contribute to their overall second lowest regional placement.
#4 Overall sleep score: 69.5
The South earns the second best snore score, and is second for going to the doctor in the past year. In all other determining factors, the South loses out by scoring the lowest. This again demonstrates the multi-directional relationship between physical health, mental health, and sleep health.
Several of the top ten cities — including Denver, Albuquerque, Portland, and Oakland — earned the best sleep quality rating. These cities also earn relatively strong snore scores, have higher percentages of residents with health insurance, and relatively lower risks for obesity, diabetes, and mental health risks.
Seattle’s landscape is surrounded by either bodies of water or lush nature, which makes it one of the most sought-after destinations in the Pacific Northwest. Seattle’s excellent sleep quality rating is coupled with a positive snore score. Ninety-two percent of Seattle residents have health insurance, and only 7% are at risk for diabetes.
Also, 87% of the population reports having leisure time, which is the highest percentage per capita in the top and bottom 10 cities. Sleep is connected to mental and emotional health, and issues with sleep have been linked to depression, anxiety, bipolar disorder, and other conditions. Seattle residents’ strong relationship with their mental health and the resources necessary to maintain this, coupled with their high sleep quality rating and snore score, is why the city earns the top spot for sleep.
Home to beloved sports teams and rich with history, San Francisco has long been one of California’s most popular tourist destinations. According to Walk Score, San Francisco is a very walkable city in the United States, promoting a healthy and active lifestyle for residents.
Only 17% and 9% of the San Francisco population are at risk of obesity and diabetes, respectively. Additionally, 82% of residents report having leisure time, and two-thirds of the population report sleeping seven or more hours a night. These positive percentages poise San Francisco residents to achieve quality sleep.
With 300 days of annual sunshine, mild temperatures and record snowfalls, there’s never a bad time be in Colorado. Ranking third place, Colorado Springs is home to some of the Rocky Mountains’ best sleepers.
This city has the second highest percentage per capital with no mental health risk (88%), and 83% report having leisure time. Considering these positive factors, coupled with the strong sleep quality that Colorado Springs residents achieve, they rank as the third-best city for sleep.
The Mile High City adds another Colorado town to the top ten list, scoring the second highest snore score of the top and bottom 10 cities. Sleep at high altitude can correlate to poor subjective sleep quality, but the data suggests that Coloradans still seem to achieve quality sleep.
Reporting 5.5% unemployment in August 2021, Denver also has a growing economy in tech, telecom, and medical professions. With its flat landscape, urban Denver is also a great city for bikers. While more than three-quarters of the Denver population reported having leisure time, the outdoors provide excellent opportunities for physical activity. These two factors may contribute to Denver residents’ sleep quality.
Home to a stretch of Route 66 and more than 300 days of sunshine, Albuquerque earns some of the highest sleep ratings on this list. While only 67% of the Albuquerque population report sleeping seven or more hours per night, the quality of sleep rating is the highest of any cities on the list, tying with Denver, Portland, and Oakland in this category.
While 27% of the population is at risk for obesity and 10% is at risk for diabetes, 87% have health insurance — and a decent percentage of the population use it: 68% and 69% of the population got a doctor and dental check-up in the last year, respectively.
Residents of Minneapolis may lose less sleep over lack of work — this is the sixth best city in the nation for sleep, and reports a 3.5% unemployment rate in August 2021. This city is considered very walkable by Walk Score, which also named Minneapolis the most bike friendly city in the United States.
Over three-quarters of the city’s population reports having leisure time, so residents may be taking advantage of their easy access to walking, biking, and other similar activities. These three factors may contribute to days of physical movement and nights of quality sleep.
“We have a well-educated, health conscious and well-informed population regarding the importance of obtaining sufficient, high-quality sleep for maintaining optimal health and performance at work and with our family lives, and in other spheres of our lives,” said Dr. Ranji Varghese, Medical Director of the Minnesota Regional Sleep Disorders Center.
According to Walk Score, Portland is one of the most bike friendly cities on the West Coast. Getting around town in an active way is an easy method for residents to incorporate consistent exercise into their routines, which can contribute to a healthy sleep schedule.
Eighty-nine percent of residents have no diabetes risk, and nearly two-thirds of the population report sleeping seven or more hours a night. Similarly, 86% of the Portland population has no mental health risk. Portland’s data supports the concept that a healthy body and mind can correlate with healthy sleep.
Nestled in the Bay Area, Oakland has the highest sleep quality rating of all top 10 and bottom 10 cities, tying with Denver, Albuquerque, and Portland. Out of the four, Oakland has the second strongest snore score.
The Oakland population doesn’t sleep for quite as long as the other top sleep cities, and this city’s residents also report having less leisure time. But, as the eighth largest city in California, Oakland has a vast array of cultural events and outdoor activity options. Having access to a fulfilling social environment can promote a positive impact on sleep.
While the population in Anchorage, AK has the lowest snore score, tying with Corpus Christi, TX, Anchorage’s sleep quality rating is the third best, beating out all bottom 10 cities on this list in this category.
Sixty-five percent of Anchorage residents report sleep seven or more hours per night, a higher percentage per capita than all bottom 10 cities — as well as a few of the top 10 cities, including Oakland and Pittsburgh. More than three-quarters of the Anchorage population report having leisure time, at 80%.
This city also has the sixth highest percentage of people who do not have a risk for obesity and third highest percentage of people with no diabetes risk. Anchorage is well insured, with 91% of the population having coverage. Combining these positive physical health numbers with access to leisure time to enjoy the plentiful beauty that the outdoors of Anchorage has to offer, this city makes the top 10 list for its residents to be able to consistently achieve quality sleep.
Pittsburgh’s snore score is the strongest of all cities on this list. This means that while Pittsburgh sleeps, the city is least likely to experience snore-related sleep events that impede the quality of their zzz’s. This Pennsylvania population also has the highest percentage of people per capita, 78%, who had a doctor check in the last year.
Preventive and follow-up measures like visiting the doctor can help this population keep sleep-related conditions at bay and keep tabs on conditions they may already have.
Boasting 400 miles of trails, there are ample opportunities for biking and walking — a quality that lends itself well to college students, since the Pittsburgh region is home to 34 colleges and universities. Access to upholding an active lifestyle helps Pittsburgh make it to the top 10 on this list.
When analyzing the worst cities for sleep, a few patterns were identified. Out of the worst cities for sleep, nine of the 10 have higher risk levels for obesity, diabetes, and mental health issues. Sleep deprivation is linked to issues with weight loss, as well as a loss of motivation for physical activity.
These risk factors can contribute to both physical and mental health, which can correlate with low sleep quality. In fact, all of the bottom 10 cities have average or below average sleep quality scores. This web of factors demonstrates the multi-directional relationship that physical, mental, and sleep health have on one another. Residents of these cities and others can connect these patterns to their own lives in consideration for how they may optimize their opportunities to achieve high quality sleep.
Located in southern Texas on the Gulf of Mexico, the population of Corpus Christi is at a higher risk for obesity, diabetes and mental health issues than some other cities on this list, per capita. Roughly 65% of residents sleep seven or more hours a night, while maintaining the lowest snore score. This suggests that when Corpus Christi residents are actually sleeping, these sleep sessions may be punctuated with snore-related sleep events.
Dr. Michael Grandner, Ph.D., instructor of psychiatry, and sleep expert, notes that sleep is closely tied to health, in that “not only can lifestyle factors influence sleep health, but sleep problems can lead to more problems with maintaining a healthy diet and activity pattern as well as more problems with smoking and other health risks.”
Also of note, more people per capita in Corpus Christi than any other city on this list are at risk for obesity — 40% of its population. Due to the link between sleep deprivation and unhealthy food choices, chronic sleep loss has been linked to having issues with maintaining a healthy weight.
Los Angeles is home to some of the biggest names in the film and entertainment industry, and is also known for its tourism. The City of Angels comes in last place in several categories, including the percentage of the population that report having leisure time, a dental or doctor check-up in the past year and a higher diabetes risk than some other cities on this list.
More than half of Los Angeles residents do not have health insurance, and only 66% of participants reported having leisure time — the lowest ranking city per capita on this list.
A mere 30 miles from Los Angeles, Santa Ana, CA also experiences issues with sleep. Only 66% of Santa Ana residents report having a doctor check-in last year, the lowest percentage per capita on this list. Similarly, only 57% of the city’s population had a dental check-up in the past year. Per capita, Santa Ana has the fourth lowest percentage of people with health insurance.
Not only can these factors influence each other, but they may also take a bite out of residents’ quality sleep: This city has the third lowest snore score and a lower-than-average sleep quality rating. When the city is sleeping, residents may find it a challenge to sleep soundly due to snore-related sleep events.
Tucked in the central California valley with some of the state’s hottest temperatures, Fresno residents sleep less per capita than any other city on this list — just 60% of the population sleeps seven or more hours per night.
External temperatures can interfere with the body’s natural regulation of body temperature that occurs during sleep. If your bedroom is too warm — as it might be during the spring, summer, and early fall — then this can increase your body temperature and disturb your sleep.
With ongoing drought and fire issues, which can particularly impact the central valley, Fresno residents also experience impacted sleep due to lack of proper air ventilation or air conditioning in homes.
Another California town with impacted sleep is Bakersfield, which reports that only 54% of residents visited the dentist in the past year. With fewer dental care check-ups, symptoms of sleep bruxism (teeth grinding) may go untreated or cause long-term health effects.
Additionally, Bakersfield reports an unemployment rate of 10% for August 2021. Unemployment is a multi-faceted issue that contributes to various factors that might hinder quality sleep, such as higher stress levels from emotional or financial hardship. Bakersfield also earned one of the lowest sleep quality ratings of all cities on this list.
These factors may contribute to Bakersfield’s challenge in achieving consistent, restorative sleep.
Known for its vibrant nightlife and steady stream of tourism, Miami is home to more than two million residents. Only 63% of the population report sleeping seven or more hours a night. Having access to exciting nightlife like bars that stay open late into the night can impact residents’ sleep quality, not to mention sleep duration.
Miami is a coastal sun-lover’s and biker’s paradise, so this factor may increase the potential for exercise and sun exposure during the day. For this reason, it’s possible to counteract some effects of poor sleep with increased activity during waking hours.
According to Walk Score, this central Texas town has minimal public transportation and does not have many bike lanes. As moving about in Fort Worth may often require a car, opportunities for getting exercise may come less often.
So while 73% of the Fort Worth population report having leisure time, residents may find it more difficult to spend their leisure time engaging in physical activity, or to be active while running errands, if they need to ride in a car more often.
Moderate-to-vigorous physical activity, such as walking, can not only allow people to feel more tired at the end of the day, but such activity can also decrease the risk of excessive weight gain, which in turn makes that person less likely to experience symptoms of obstructive sleep apnea (OSA).
With a population of over half a million people, Detroit is Michigan’s largest city by size and population, according to the U.S. Census. Detroit earns a strong snore score in comparison to many other cities; however, its other determining factors contribute to Detroit’s low place on this list.
The other factors that cause Detroit to rank as the eighth worst city for sleep on this list include its population’s sleep duration: Over a third of Detroit residents, 39% of the population, sleep seven or fewer hours per night.
When sustained sleep loss is combined with other factors, such as 30% of people reporting a lack of leisure time, and only 57% of people seeing a dentist in the past year, this city can struggle to achieve consistent, high-quality sleep.
Only a little over half of the Sacramento population, 54%, reported having a dental check-up in the past year. This city’s population also has the highest percentage per capita of people with mental health risk of all cities on this list.
Considering the interdependence of sleep, physical, and mental health, factors like fewer dental care check-ups and a higher mental health risk may contribute to Sacramento’s struggle to sleep.
Additionally, almost one-third of the population — 32% of Sacramento residents — report having no leisure time, which is the second highest percentage per capita on this list. The capital city dwellers are busy folks, which may hinder their ability to unwind before sleep with a bedtime routine.
Also known as Sin City, Las Vegas is located in the southern tip of Nevada, and is known for its nightlife, larger-than-life tourism attractions, and historic downtown. The lights on and around the strip never sleep, and such light pollution may cause residents to lose sleep, too.
Las Vegas has the third lowest sleep quality rating, tying with Bakersfield and Santa Ana, and only beating out Detroit, Miami, and Corpus Christi. Las Vegas also has the fourth lowest percentage per capita of people who sleep seven or more hours per night — just 63% of its residents report getting ample shut-eye.
For those living in close proximity to the sights and sounds of downtown Las Vegas, there may be concerns around creating a quiet and calm sleep environment.
The state of sleep is precarious here in the United States. Some places sleep well, while others toss and turn. Sleep Cycle’s sleep data, along with CDC and Census data, suggests that our sleep, physical, and mental health are not isolated from one another.
Knutson recognizes the multi-directional impact of these factors: “Sleep health both impacts and is impacted by other health behaviors.”
This relationship between our mental, physical, and sleep health can feel like a virtuous or vicious cycle. Knutson notes that “trying to break a vicious cycle is challenging, but it can have broad health benefits.”
But, there is hope. “The good news is that sleep is much easier to change than some other aspects of health,” Grandner says. “Even small changes to your sleep routines can lead to more restful sleep, which can in turn have positive impacts on health.”
When we begin to understand the cyclical relationship of our physical, mental, and sleep health, we can inform our decisions and collectively advocate for better sleep.
Even if you live in a top 10 city, you may still be experiencing sleep issues. No matter where your hometown falls on this list, a good night’s sleep is essential and — most importantly — achievable.
You can implement steps to sleep better by trying some of the below sleep tips. Knutson suggests to remain mindful, as they “could be the first step towards healthier sleep; however, if you still don’t feel rested, or if you snore, you should speak to a doctor to make sure you don’t have a sleep disorder, like sleep apnea or insomnia.”
Tips for achieving quality sleep:
If your hometown didn’t make the top 10 or bottom 10 list, you can still see how others stack up against one another across the country. The list below contains U.S. cities with populations of 250,000 or greater and their overall scores. Scroll up and down within the table to see the full list.
|2||San Francisco, CA||77.52|
|3||Colorado Springs, CO||77.16|
|11||Long beach, CA||75.4|
|21||Virginia Beach, VA||74.38|
|22||New York, NY||74.37|
|24||Fort Wayne, IN||74.27|
|35||St. Louis, MO||73.72|
|42||New Orleans, LA||73.52|
|43||San Jose, CA||73.51|
|45||Oklahoma City, OK||73.34|
|52||El Paso, TX||72.95|
|53||Kansas City, MO||72.87|
|56||San Antonio, TX||72.63|
|57||San Diego, CA||72.5|
|60||Las Vegas, NV||72.29|
|63||Fort Worth, TX||72.01|
|67||Santa Ana, CA||71.4|
|68||Los Angeles, CA||70.23|
|69||Corpus Christi, TX||69.5|
*Scroll up and down within the table to see the full list.
Sleep Foundation is based in Seattle, WA, with employees across the United States including TX, NY, NJ, CO, and elsewhere. Sleep Foundation collaborated with Sleep Cycle, based in Gothenburg, Sweden. Due to the locations, we acknowledge that there is potential for bias.
Sleep tracking devices continue to grow in popularity, and their accuracy continues to be studied and developed. As sleep tracking devices become more widespread, the increase in the collected samples allow data to become more standardized. The dataset used for this analysis factored in a minimum amount of observations and samples to ensure data quality.
For further information or for media inquiries, contact the editor at [email protected].