Journal of Public Health VoI. 27, No. 2, pp.

205–211
doi:10.1093/pubmed/fdi004 Advance Access Publication 7 March 2005

Who has time to sleep?

Lauren Hale

Abstract And finally, it may build additional awareness of the import-

ance of sleep hygiene to the non-sleep research community.
Background Both marriage and education appear to con-

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fer a protective effect on health. Few studies have examined
Sleep and health
the extent to which both undersleeping and oversleeping
explain these relationships. I examined whether marital status, The relationship between sleep duration and health is compli-
educational background, and other sociodemographic varia- cated, because there are many confounding factors and because
bles are associated with higher-risk sleep durations.
causality is likely to flow in both directions. Recent studies
Methods Over 7000 individuals aged 25–64 collected time- show that 6.5–7.5 h of sleep on an average weeknight is associ-
use diary data during a 24-h period. For both weekdays and
ated with the lowest risk of all-cause mortality.1–3 Controlling
weekend days, separate multinomial logistic regression mod-
els were estimated using three categories of sleep duration as for demographic characteristics (e.g., age, race, education,
the outcome category. occupation, marital status), health behaviours (e.g., exercise
Results Unmarried individuals are significantly more likely level, years of smoking, fat in diet), prior health conditions (e.g.,
to sleep a short amount on both weekdays and weekends body mass index, leg pain, and history of heart disease, hyper-
compared to married people. Single people also are signifi- tension, cancer, diabetes, stroke, bronchitis, emphysema, and
cantly more likely to sleep a long amount. People with less
kidney disease) and medication use, sleeping either a long or
than a college education are significantly more likely to
sleep both a short amount and a long amount on weekdays short amount increases the relative risk of all-cause mortality
relative to the college educated. by up to 40 per cent.1 The adverse effect of sleep deprivation on
Conclusions High-risk sleep durations (short sleeping health may be due to disruption of circadian rhythms and
and long sleeping) are positively associated with sociode- impaired glucose metabolism.4–6 Whether the effects of someone
mographic categories associated with poorer health. regularly sleeping 5 versus 8 h a night are physiologically similar
More research should investigate whether social inequali- to being sleep-deprived is not well understood. Similarly, the
ties in health can be explained in part by variation in sleep
relationship between sleeping for a long time and health is not
duration.
particularly clear.1,6 Nonetheless, evidence suggests that having,
Keywords: sleep duration, marital status, education, time- on average, a long sleep duration is associated with as high, if
use studies
not higher, a mortality risk factor than having midrange or
short sleep duration on a regular basis. In addition, in a nationally
representative US sample, both short and long sleepers report
Introduction
more sleep problems (i.e. wakening during the night, wakening
Although sleep comprises the largest single use of time for most too early, wakening unrefreshed, and daytime sleepiness) com-
adults, social scientists have rarely used time-use data to pared to the midrange sleepers (7 or 8 h).7
explore how sleep duration varies by education, marital status,
and other sociodemographic characteristics. This paper Health and sociodemographic factors
explores these relationships in order to identify the characteris- An extensive literature investigates the positive associations
tics of individuals that are at a higher risk of sleeping either a between socioeconomic status and health and between marriage
short amount or a long amount, controlling for other poten- and health.8–10 Some of this may be due to selection bias. For
tially confounding factors. example, healthier people may be more likely to get married than
This information can assist public health and health care unhealthy people.11 In addition, health behaviours such as
professionals in identifying segments of the population that are smoking and nutrition can explain some of these associations.8,12–14
at higher risk for sleep disorders or potential sleep-related dis-
orders. Secondarily, an understanding of these correlations may
RAND Corporation
provide help in explaining other areas of research that are not
Lauren Hale, PhD
fully understood, such as social inequalities in health and test
Address correspondence to Lauren Hale, RAND Corporation, 1776 Main Street,
score gaps. This research may guide social scientists to incorpo- Santa Monica, CA 90407, USA.
rate sleep and other biological variables into future analyses. E-mail: [email protected]

© The Author 2005, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
206 JOURNAL OF PUBLIC HEALTH

Other likely explanations include psycho-social stressors and late nights or sleeping in. Then again, people with a lot of finan-
neighborhood factors, which may disproportionately threaten cial uncertainty or family responsibilities may use late hours of
the well-being of the less-educated and unmarried segments of the night to find the time to address their needs.
the population.15–17 To a lesser extent, health care access and Sleeplessness is likely to result from psychosocial problems and
utilization play a role.18,19 physiological responses to the chronic stressors of everyday life.
I hypothesize that people who have greater chronic stressors are
Sleep and sociodemographic characteristics more likely to have reduced sleep time because of sleepless nights.
Despite the clear associations between sleep and mortality People who work the night shift or other unconventional hours are
described above, very few studies explicitly investigate how also likely to have disrupted circadian rhythms that make sleeping
sleep patterns relate to sociodemographic characteristics. The difficult. An additional potential cause for difficulty sleeping is
few studies5,20,21 that explore these relationships are limited by adverse environmental conditions, such as noisy living space in a
sample size, available variables, and generalizability. Further, city environment, or crowded living spaces or bedrooms (see
Conley22 for an analysis of the effect of household crowding on

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they fail to consider the risks of short sleeping and long sleeping
separately. educational attainment). I expect that disruptive sleeping condi-
Biddle and Hamermesh argue that ‘sleep is subject to con- tions that might result in short sleep durations would be more
sumer choice, and is affected by the same economic variables common among poorer and/or urban respondents.
that affect choices about other uses of time’ (ref. 20, p. 941).
Their investigation of time-use data indicated that each additional
hour of work costs between 7 and 10 min of sleep, based on a Materials and methods
linear regression model that controls for age, education, marital
status, children in household, religion, and hours worked. Their Design of the American Use of Time Studies
main focus was on the relationship between sleep duration and This study analyses data from a subset of four cross-sectional
hours in the work force. They did not speculate about the impli- time-use studies conducted in 1965, 1975, 1985, and 1999.
cations of the correlations between sociodemographic factors While these studies all have the same principal investigator,
and sleep. they differ in sample size and somewhat in methodology. The
In another study, social psychologists investigated the roles first three of the studies are part of the Americans’ Use of Time
that sleep quality and duration play in understanding the rela- Project.23 In the fall of 1965, 1244 adults aged 18–64 received a
tionships between income/education and mental/physical health. brief at-home ‘warm-up’ interview along with a diary for the
They used the Detroit Area Study to show that self-reports of respondent to record their next day’s activities. On the day after
sleep quality are related to both mental and physical health, as the activities were recorded, an interviewer returned to the
well as to education and income.21 While sleep duration was respondent’s home to ensure that the diary was filled out com-
associated with health, it was not related to education or pletely. In 1975, a similar survey was conducted of 2406 individ-
income in that study.21 uals aged 18 and over. This survey over-sampled Sundays and
One major limitation of both of the above analyses is that under-sampled Saturdays. The 1985 survey consisted of per-
they only consider sleep as a continuous linear variable. As a sonal interviews, telephone interviews, and mail-back diaries.
result, they do not allow for the possibility of a non-linear rela- This survey was spread over the course of the year interviewing
tionship between sociodemographic characteristics and sleep over 5000 people in total. The 1999 survey comes from the
duration by exploring both ends of the sleep duration distribution. Family Interaction, Social Capital and Trends in Time Use24
which interviewed 1151 individuals aged 18 and over. In every
year, the individual recorded his or her activity between 12:00
The current study
AM until 12:00 AM using open-ended diary entries across the
In the current study, I use data from time-use diaries to identify full 24-h periods using the same basic codes for diary activities.
the sociodemographic risk factors for being both short and long The subsample of individuals included in the current analysis
sleepers. To my knowledge, this study provides the only multi- was restricted to those people between age 25 and 64 to avoid
variate analysis of the sociodemographic correlates of sleep that confounding factors of college attendance and retirement in the
allows for a trichotomy of sleep durations. This is particularly analyses. Four additional individuals were excluded because no
useful in light of recent research on the risks of both short sleep- amount of sleep activity was recorded. In the analyses reported
ing and long sleeping. below, we consider 1096 individuals from 1965, 1710 from
I hypothesize that the time someone goes to bed and rises is 1975, 3514 from 1985, and 825 from 1999.
strongly related to his or her social experiences and behavioural The analysis estimates a multinomial logistic regression
demands. Hours spent in the labour force, for example, will be equation on the amount of sleep reported for the 24-h period of
an important factor in determining the times for waking and the time-use diary. The three outcome categories are short
sleeping. Those with stable full-time jobs will be more likely to sleep, midrange sleep, and long sleep. The definition of short
have a structured schedule that does not allow for extremely sleep is less than 6.5 reported hours, whereas the definition of
 WHO HAS TIME TO SLEEP? 207

long is greater than 8.5, with the midrange sleep being in were used as the diaries for weekend and the Monday through
between. In another study,7 a range of 7–8 h was used as the Friday diaries were used as the weekday diaries. Since the diaries
midrange amount of sleep for a typical night. For that study, are recorded from 12:00 AM to 12:00 AM, Friday’s diary starts
the data did not differentiate time sleeping into anything on a weekday morning and ends on a weekend night, and con-
smaller than one-hour increments. The 6.5–8.5 h time range versely, Sunday’s diary starts on a weekend morning but ends
allows for a more generous definition of a midrange duration of on a weekday night.
sleep, and is based on epidemiological studies that suggest this This initially was a concern, but there were qualitatively similar
is range of sleep duration is associated with lower mortality results when the weekday model was run without Friday and
risks.1,2 The explanatory variables are dichotomous variables the weekend model was run without Sunday. Another model
for calendar year, marital status, gender, educational status, was estimated to test for the interaction effects of weekend with
employment, and minutes of television watched per day (in 1 h all of the covariates.
intervals). Age and age-squared are also included as continuous

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variables.
The regression equations are estimated separately for reports Results
taken during weekdays (Monday through Friday) and the week- Table 1 shows the frequency of each personal characteristic for
end days (Saturday and Sunday). Saturday and Sunday diaries the entire sample, and then separately for the weekday sample

Table 1 Proportions of dependent and independent variables in the entire sample, the weekday sample, and the weekend
sample (standard deviations are shown in parentheses)

Participant Entire sample Weekday diaries Weekend diaries

characteristic (n ⴝ 7095) (n ⴝ 5172) (n ⴝ 1923)

Sleep duration 7.7 (1.8) 7.5 (1.7) 8.3 (1.9)

Age 41.6 (11.2) 41.6 (11.2) 41.5 (11.1)
Year
1965 0.147 0.148 0.145
1975 0.241 0.244 0.232
1985 0.495 0.492 0.505
1999 0.116 0.115 0.119
Gender
Female 0.546 0.551 0.534
Male 0.454 0.449 0.466
Marital status
Married 0.741 0.741 0.738
Separated/divorced 0.108 0.109 0.104
Widow 0.038 0.038 0.038
Single 0.114 0.112 0.120
No information on marital status .003 .003 .001
Educational status
<High school 0.190 0.193 0.181
High school graduate 0.565 0.564 0.565
College graduate 0.158 0.160 0.155
Graduate school 0.087 0.083* 0.098*
No information on education .006 0.006 0.005
Employment status
No job 0.040 0.040 0.042
Retired 0.045 0.045 0.047
No work hours 0.295 0.300 0.281
Work hours 10–35 0.105 0.103 0.109
Work hours 36–50 0.412 0.409 0.419
Work hours 50 plus 0.103 0.103 0.102
Minutes/day watching TV
No TV 0.183 0.251 0.239
1–60 min 0.189 0.197*** 0.146***
61–120 min 0.147 0.201*** 0.156***
121–180 min 0.233 0.146 0.150
> 180 min 0.183 0.204*** 0.309***

***p < 0.001; **p < 0.01; *p < 0.05 for a comparison of proportions test between the weekday and weekend samples.
208 JOURNAL OF PUBLIC HEALTH

and the weekend sample. On the weekdays, the average night This exception occurs among the people who work more than
recorded 7.5 h of sleep, whereas on the weekends, it is 8.3 50 h a week. Consistent with the economics literature,20 among
(p < 0.001). The rest of the table shows that there are few significant the long workers, the percentages of sleep duration are in the
differences between the weekday and weekend populations. The order of Midrange Sleepers > Short Sleepers > Long Sleepers.
differences that do exist are primarily with regard to television- Table 3 provides the results from the multinomial logistic
watching behaviour. In addition, there are slightly more graduate regression models, where the first two columns provide the
school-educated respondents on the weekend compared to a results for the weekdays and the third and fourth columns show
weekday. the results for the weekend days. The regression coefficients are
Table 2 shows the distribution of personal characteristics by exponentiated and presented as odds ratios to facilitate their
time slept, where each row sums to 1.0. The majority (54 per interpretation. All groups of categorized variables significantly
cent) of the sample slept within a range of 6.5–8.5 h. Around 27 contribute to the model using a likelihood-ratio test. In the
per cent were classified as long sleepers and 19 per cent as short pooled model with both weekday and weekend diary data, the

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sleepers, defined as more than 8.5 hours and less than 6.5 h of addition of interaction terms between weekend and all covariates
sleep, respectively. The pattern of Midrange Sleepers > Long contributed significantly to the model using a likelihood-ratio
Sleepers > Short Sleepers exists when the sample is stratified by test. Thus, weekend sleep differs significantly from weekday
each of the above personal characteristics, with one exception. sleep patterns.

Table 2 Proportions of dependent and independent variables, by amount of sleep (standard deviations shown in parentheses)

Short sleep Midrange sleep Long sleep

(< 6.5 h/night) (6.5–8.5 h/night) (> 8.5 h/night)
(n ⴝ 1321 or 19%) (n ⴝ 3832 or 54%) (n ⴝ 1942 or 27%)

Sleep duration 5.2 (1.3) 7.5 (.6) 9.8 (1.2)

Age 41.3 (11.0) 41.9 (11.1) 41.3 (11.6)
Year***
1965 0.187 0.601 0.211
1975 0.153 0.54 0.307
1985 0.201 0.53 0.268
1999 0.188 0.506 0.307
Gender***
Female 0.167 0.562 0.283
Male 0.209 0.528 0.263
Marital Status***
Married 0.168 0.563 0.270
Separated/divorced 0.234 0.503 0.263
Widow 0.254 0.485 0.261
Single 0.240 0.448 0.313
Educational status+
<High school 0.186 0.54 0.274
High school graduate 0.193 0.538 0.27
College graduate 0.167 0.575 0.258
Graduate school 0.186 0.548 0.267
Employment status***
No job 0.171 0.455 0.374
Retired 0.125 0.467 .408
No work hours 0.162 0.545 0.294
Work hours 10–35 0.159 0.555 0.286
Work hours 36–50 0.201 0.553 0.246
Work hours 50 plus 0.258 0.525 .217
Minutes/day watching TV***
No TV 0.231 0.511 0.257
1–60 min 0.182 0.580 0.238
61–120 min 0.167 0.579 0.254
121–180 min 0.156 0.560 0.284
> 180 min 0.176 0.496 0.329

***p < 0.001; **p < 0.01; *p < 0.05; +p < 0.10 for chi-squared test for the hypothesis that the rows and columns are independent
 WHO HAS TIME TO SLEEP? 209

Table 3 Results of multinomial logistic regression equations, in odds ratios

Weekday Weekend
........................................ ......................... ........................................ .........................
Short versus Long versus Short versus Long versus
midrange sleep midrange sleep midrange sleep midrange sleep

Year
1965 0.80 0.57*** 0.81 0.65*
1975 0.71* 0.86 0.99 1.27
1985 1.03 0.93 0.93 0.72*
1999 – – – –
Gender
Female .80** 1.06 0.69* 0.88
Male – – – –

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Marital status
Married – – – –
c c
Separated/divorced 1.29* 1.08 2.60*** 0.97
Widow 2.04*** 1.11 1.89+ 0.67
Single 1.61*** 1.28* 2.06** 1.51*
No information on marriage 0.78 0.74
Age variables
b b
Age 0.98 0.91*** 1.04 1.00
b b
Age squared 1.000 1.001* 1.000 1.000
Educational status
<High school 1.43** 1.61*** 1.77+ 1.06
a a
High school or more 1.24* 1.19 1.91* 0.96
College graduate – – – –
Graduate school 1.16 0.96 1.02 1.03
No information school 0.44 0.45
Employment status
a a
No job 1.28 1.43* 0.54 1.20
b b
Retired 0.94 1.90** 0.39+ 0.95
Work hours < 36 – – – –
Work hours 36–50 1.18 + a
0.75*** 0.98 a
0.93
Work hours 50 plus 1.45** 0.75* 1.71* 0.92
Minutes/day watching TV
No TV – – – –
c c
1–60 min 0.68*** 0.73** 0.82 1.28
b b
61–120 min 0.63*** 0.77* 0.66+ 1.18
b b
121–180 min 0.61*** 0.81+ 0.69 1.24
a a
> 180 min 0.78* 0.94 0.74 1.33*
Log-likelihood −4909.3 −1834.0
Wald chi2 258.6 114.5
Persons 5172 1923

***p < 0.001; **p < 0.01; *p < 0.05; +p < 0.10. A model pooling weekdays and weekend days was estimated to test whether the interaction between weekend
and all other covariates are significant. Significant interaction effects are indicated with the letter symbol to the left of the coefficient: ap < 0.10; bp < 0.05; cp < 0.01.

Marital status is correlated with sleep duration. On the suggests that sleep duration should not be constructed as a linear
weekdays, relative to being married, the separated/divorced outcome, as has been done in previous studies.20,21
(OR = 1.29, p < 0.05), widowed (OR = 2.04, p < 0.001), and single Education is also associated with sleep duration. People
people (OR = 1.61, p < 0.001) are more likely to be short sleepers without a high school degree are both more likely to be short
over midrange sleepers compared to married people. On the sleepers (OR = 1.43, p < 0.01) and long sleepers (OR = 1.61,
weekend, there is an increased risk of short sleeping for the sep- p < 0.001) on the weekdays and they are also more likely to be
arated/divorced (OR = 2.60, p < 0.001) and single (OR = 2.06, long sleepers (OR = 1.77, p < 0.05) on the weekends, relative to
p < 0.01). Single people also have an increased risk of long people with a college degree. Relative to the college educated,
sleeping on weekdays (OR = 1.28, p < 0.05) and weekends high school graduates have an increased risk of short sleeping
(OR = 1.51, p < 0.05) compared to married people. Finding that on the weekdays (OR = 1.24, p < 0.05) and on the weekends
being single increases the risk of both short and long sleeping (OR = 1.91, p < 0.01).
210 JOURNAL OF PUBLIC HEALTH

There is no consistent trend over the four years in which the their married counterparts.14 On the other hand, unmarried
data was collected. This may be due to variation in how the sur- people may require more time in order to manage the household
veys were conducted. Out of the twelve odds ratios estimated (errands, financial responsibilities). Unmarried people also may
for the year dummy variables, only four of them had a p < 0.05. have less social support and may have more difficulty sleeping
In 1965, the risk of long sleeping was much smaller on the appropriate amounts. Other reasons for the shortened (or
weekdays (OR = 0.57, p < 0.001) and the weekends (OR = 0.65, lengthened) sleep schedule among the unmarried may be due to
p < 0.05) than it was in 1999. In 1975, the risk of short sleeping mourning a separation/divorce or the loss of a spouse, which
was reduced (OR = 0.71, p < 0.05) compared to 1999 on the may be physiologically disruptive. There are likely additional
weekdays. The risk of long sleeping on the weekend in 1985 third-factor variables and reverse causality. For example, per-
compared to 1999 was also reduced (OR = 0.72, p < 0.05). For sonality characteristics that are linked to sleep habits may also
all four of these statistically significant relationships, the risk of be linked to success on the marriage market.
sleeping outside of the 6.5–8.5 h range is higher in 1999. This Explanations for the higher risk of sleeping a short or a long

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suggests that even after controlling for sociodemographic amount for the less educated people are less clear. Causality
changes, there has been an increase in non-midrange sleepers could flow in either direction: midrange sleep duration could
during these four decades. cause high education or high education causes a midrange
Women are less likely than men to be short sleepers on the amount of sleep. In the first case, if poorer sleepers are always
weekdays (OR = 0.80, p < 0.01) and weekends (OR = 0.69, tired, this may affect their studying behaviour and educational
p < 0.05). There is no difference between men and women in attainment. If causality flows from education to sleep, a potential
terms of the risk of being a long sleeper. mechanism is that high levels of education may cause people to
The age variables only show statistically significant differences choose lifestyles that are healthier for them, including going to
with regard to long sleeping on the weekdays, even after con- bed and waking at a regular hour each day. Another likely
trolling for retirement. There is no statistical significance of the explanation is that people with greater education may have a
age variables for the weekends, although there is a significant fewer number of chronic stressors and thus maybe be able to
interaction between weekend and both of the age variables for sleep sounder at night.
sleeping too long (p < 0.01). The finding with regard to television watching needs more
Retirement and having no job both increase the risk of long research. According to the results described above, a moderate
sleeping on weekdays (OR = 1.90, p < 0.01 and OR = 1.43, amount of television watching is associated with average duration
p < 0.05, respectively). On the weekends, there is a reduced risk sleeping. This may indicate that people who do not watch any
of short sleeping for the retired (OR = 0.39, p < 0.10). People television are too busy to watch television or to sleep enough.
who work more than 50 h per week have an increased risk for Whether watching television should be advised to people who
short sleeping and a decreased risk for long sleeping on the lack good sleep habits is not clear from this result.
weekdays (OR = 1.45, p < 0.01 and OR = 0.75, p < 0.05, respec- The use of a trichotomy of sleep categories proved an effective
tively) compared to people who work less than 35 h a week. way of categorizing people’s sleep durations. Whereas previous
These results confirm the finding that working longer hours research on sleep duration and education did not find a statis-
increases the likelihood of sleeping too little.20 tically significant association, these researchers did not look at
Finally, relative to people who watch no television during the possibility that the relationship is nonlinear. The clue to
the day on the weekdays, the risk of short sleeping and long this non-linearity comes from the sleep science literature that
sleeping is significantly smaller for all categories of television clearly shows a J-shaped curve in the relationship between
watching duration (with the important exception of the positive sleep duration and mortality risk, controlling for a variety of
association between watching more than 180 min and long other factors.1,2
sleeping). One might expect that watching television might sub- There are many implications of this in terms of understand-
stitute for sleep, and would increase the risk of being a short ing the larger story of social differences in health. Assuming
sleeper. Instead people who watch no television at all are more that short and long sleepers have a higher mortality risk, the
likely to be short sleepers. findings with regard to marriage may help explain the protec-
tive effect of marriage found in a number of studies. This study
identifies that marriage confers a protective effect on sleep
Discussion behaviours. Similarly, this study identifies that education also
The results described above provide an opportunity to discuss confers a protective effect on sleep behaviours, and shows that
possible explanations. it would be useful for future studies of social inequalities to
With regard to marriage, unmarried people may have more consider sleep duration. To the extent that sleep duration does
flexibility with their sleep schedule since they are less likely to explain the widely observed health inequalities, public health
share a bedroom with another person. They may use this flexibility programmes may want to target sleep hygiene education
to either sleep longer or to do other things.14,15,19 Unmarried programmes to populations (unmarried and less educated) that
men, for example, binge drink and smoke marijuana more than are observed to be at a higher risk of either short or long sleeping.
 WHO HAS TIME TO SLEEP? 211

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