The finding that a large percentage of middle school and high school students who do not get enough sleep on school nights provides an opportunity for promoting sleep health in schools, including addition of sleep health to curricula and delaying school start times to permit students adequate time for sleep.

This is the first report to provide state-level estimates of short sleep duration among middle school and high school students using age-specific recommendations from the American Academy of Sleep Medicine. A majority of both middle school and high school students in states and large urban school districts included in this report get less than the recommended amount of sleep, putting them at an increased risk for several chronic conditions.

Insufficient sleep among children and adolescents is associated with increased risk for obesity, diabetes, injuries, poor mental health, attention and behavior problems, and poor academic performance (1–4). The American Academy of Sleep Medicine has recommended that, for optimal health, children aged 6–12 years should regularly sleep 9–12 hours per 24 hours and teens aged 13–18 years should sleep 8–10 hours per 24 hours (1). CDC analyzed data from the 2015 national, state, and large urban school district Youth Risk Behavior Surveys (YRBSs) to determine the prevalence of short sleep duration (<9 hours for children aged 6–12 years and <8 hours for teens aged 13–18 years) on school nights among middle school and high school students in the United States. In nine states that conducted the middle school YRBS and included a question about sleep duration in their questionnaire, the prevalence of short sleep duration among middle school students was 57.8%, with state-level estimates ranging from 50.2% (New Mexico) to 64.7% (Kentucky). The prevalence of short sleep duration among high school students in the national YRBS was 72.7%. State-level estimates of short sleep duration for the 30 states that conducted the high school YRBS and included a question about sleep duration in their questionnaire ranged from 61.8% (South Dakota) to 82.5% (West Virginia). The large percentage of middle school and high school students who do not get enough sleep on school nights suggests a need for promoting sleep health in schools and at home and delaying school start times to permit students adequate time for sleep.

The Youth Risk Behavior Surveillance System was designed to estimate the prevalence of health risk behaviors among students that contribute to the leading causes of death and disability in the United States at the national, state, territorial, tribal, and large urban school district levels.* Students complete an anonymous, voluntary, school-based paper-and-pencil questionnaire during a regular class period after the school obtains parental permission according to local procedures. The national high school YRBS is conducted by CDC. It uses a three-stage cluster sample design to obtain a nationally representative sample of students in public and private schools in grades 9–12 (5). In 2015, the student sample size was 15,624.† The school and student response rates were 69% and 86%, respectively, resulting in an overall response rate of 60%.§

State and large urban school district high school and middle school surveys are conducted by health and education departments using a two-stage cluster sample designed to produce representative samples of students in each jurisdiction (5). These surveys are independent of CDC’s national YRBS and, unlike the national YRBS, are representative of only public school students, except in one state. To be included in this report, states and large urban school districts had to 1) have at least a 60% overall response rate, 2) include a question on sleep duration, and 3) provide permission for CDC to include their data. Thirty states and 16 large urban school districts administered a high school YRBS and met these criteria. Across these states, the student sample sizes ranged from 1,313 (South Dakota) to 55,596 (Maryland).¶ The median overall response rate was 66.5% and ranged from 60% (Indiana and North Carolina) to 84% (Virginia). Across these large urban school districts, the high school student sample sizes ranged from 1,413 (Broward County, Florida) to 10,419 (District of Columbia). The median overall response rate was 76.5% and ranged from 64% (District of Columbia) to 88% (San Diego, California).

Nine states and seven large urban school districts administered a middle school YRBS and met these criteria. Across these states, the student sample sizes ranged from 1,640 (Kentucky) to 27,104 (Maryland). The median overall response rate was 76% and ranged from 68% (Maine) to 85% (Hawaii and Virginia). Across these large urban school districts, the middle school student sample sizes ranged from 1,333 (Los Angeles, California) to 4,533 (Duval County, Florida). The median overall response rate was 81% and ranged from 68% (San Francisco, California) to 86% (Orange County, Florida). All data sets were weighted to be representative of students in the jurisdiction.

All students in the national, state, and large urban school district surveys were asked to respond to this question about sleep duration: “On an average school night, how many hours of sleep do you get?” Possible responses were 4 or less hours, 5 hours, 6 hours, 7 hours, 8 hours, 9 hours, and 10 or more hours. Short sleep duration was defined as <9 hours for students aged 6–12 years and <8 hours for those aged 13–18 years. The analytic samples were composed of students who responded to both the sleep duration question and the age question.**

Prevalences and 95% confidence intervals (CIs) of short sleep duration on an average school night were calculated overall and by sex, grade, and race/ethnicity for the national high school YRBS and for a combined data set composed of data from the nine states that included the sleep duration question in a middle school YRBS. This combined data set is not nationally representative. The overall prevalence and 95% CI of short sleep duration also were calculated separately for each state and large urban school district at both middle school and high school levels. Pairwise differences in short sleep duration prevalence among sex, grade, and race/ethnicity subgroups were determined using t-tests; differences among estimates were considered statistically significant if the t-test p-value was <0.05. Analyses accounted for the weighting of the data and for the complex sampling designs.

The overall prevalence of short sleep duration among middle school students in the nine states combined was 57.8% (Table 1). The distribution of sleep duration was 5.9% for ≤4 hours, 6.0% for 5 hours, 11.0% for 6 hours, 20.0% for 7 hours, 29.9% for 8 hours, 17.2% for 9 hours, and 10.0% for ≥10 hours. The prevalence of short sleep duration in this combined sample was higher among female students (59.6%) than among male students (56.0%). The prevalence of short sleep duration also was highest among students in grade 6 (61.3%), lowest among students in grade 8 (53.1%), and higher among black (61.1%) and Native Hawaiian/Pacific Islander (64.2%) students than among white (56.6%), Hispanic (57.3%), and Asian (55.5%) students. State-specific estimates of short sleep duration ranged from 50.2% (New Mexico) to 64.7% (Kentucky). Prevalence estimates for the seven large urban school districts ranged from 50.2% (San Francisco, California) to 61.8% (Miami-Dade County, Florida).

At the high school level, nationwide, the prevalence of short sleep duration was 72.7% (Table 2). The distribution of sleep duration was 7.5% for ≤4 hours, 12.6% for 5 hours, 22.9% for 6 hours, 29.7% for 7 hours, 20.6% for 8 hours, 5.0% for 9 hours, and 1.7% for ≥10 hours. The prevalence of short sleep duration was higher among female students (75.6%) than among male students (69.9%), lower among students in grade 9 (65.6%) than in other grades (71.7%–77.6%), and higher among black (76.5%) and Asian (79.3%) students than white (72.0%) and Hispanic (70.2%) students. State-level estimates of short sleep duration for the 30 states ranged from 61.8% (South Dakota) to 82.5% (West Virginia) (Table 2) (Figure). Prevalence estimates for the 16 large urban school districts ranged from 69.9% (Los Angeles, California) to 85.6% (Broward County, Florida).