Sleep troubles hit rural Appalachia hardest, study finds

Researchers at the University of Kentucky, with colleagues from the University of Miami and the University of Arizona, found that adults in rural Appalachian communities face a much higher burden of sleep disorders than previously understood.

The findings confirm what many in the region already experience: poor sleep creates hardship, and hardship worsens sleep. These disorders reflect a broader healthcare gap shaped by economic and social conditions.
The REST-KY project found that 64.9% of participants had clinically significant insomnia—more than six times the 10% national average.

“It’s not just, ‘I cannot sleep.’ Mental health plays a major role in these high rates,” said Daniela Moga, co-lead of the study and assistant dean for research at the UK College of Pharmacy.

The UK team recruited 327 participants from 12 economically distressed Eastern Kentucky counties and followed them for two years using surveys and two-week tracking periods every six months.
The study, published in JAMA Network Open, shows how social determinants of health shape sleep quality in underserved regions and identifies a steep socioeconomic gradient in insomnia.

Insomnia affected 82.9% of participants earning under $20,000 a year, compared with 44.4% of those earning more than $100,000. It was also linked to being female, living alone, cigarette use, poor diet, and trauma history.
The study also found that 51.3% of participants had elevated risk for obstructive sleep apnea, above the roughly 38% national average, and 44.8% reported sleeping fewer than seven hours per night.

The data also showed that 37.1% of participants had moderate to severe anxiety or depression, and 62.1% reported moderate to high stress.

Related REST-KY research published last year found that stronger social support was linked to lower insomnia severity, largely through reduced depression, anxiety, and stress.

“One of the most meaningful findings is how closely sleep is tied to broader life circumstances, including financial stability, health, and social support,” said Emily Slade, associate professor at the UK College of Public Health.
What’s next?

Because access, cost, and travel time are major barriers in rural Appalachia, researchers are focusing on interventions that do not require clinic visits.
In an earlier study, Moloney and Moga tested an app-based cognitive behavioral therapy program with women 45 and older in Eastern Kentucky.

“We showed they not only improved sleep outcomes, but also reduced their use of insomnia medications,” Moga said.
The team has since applied for funding to bring a similar app-based intervention, called Somryst, to REST-KY counties. These tools aim to improve sleep and mental health while reducing stigma and travel burdens linked to traditional care.