The high price of ignoring sleep

As far back as the 1970s, Dr. William Dement—widely regarded as the “father of sleep medicine”— was calling attention to the risks of neglecting sleep. He coined the term “the triumvirate of health” to emphasize that sleep, nutrition and physical activity are equally vital to well-being.¹

Yet, it wasn’t until 2022 that sleep finally received long-overdue recognition on a national scale. That year, the American Heart Association (AHA) elevated sleep to the status of an essential pillar of cardiovascular health, expanding its long-standing “Life’s Simple 7” to become “Life’s Essential 8.”²

For the first time, sleep was placed alongside factors like blood pressure, cholesterol, blood sugar, activity, diet, weight and smoking as a core determinant of heart health.² It was a landmark moment—one that signaled to clinicians, policymakers and the public that healthy sleep is not a lifestyle luxury, but a biological necessity.

Yet, despite the recent fanfare, sleep remains profoundly under-prioritized in clinical practice and health policy. The gap between recognition and real reform is wide, and it’s costing lives, productivity and billions in healthcare spending. This pattern is not limited to the U.S; sleep’s neglect is mirrored in health systems across the world.

Why the gap persists

• The blind spot in medical education

  The AHA’s move was not an isolated event. Over the past few years, leading sleep societies and advocacy organizations have worked tirelessly to raise healthy sleep’s profile. However, the reality on the ground remains largely unchanged.

  Nowhere is this gap more glaring than in medical education. Despite sleep’s central role in health, it receives minimal attention during training. A 2011 survey of sleep medicine education across several countries found that the average amount of time spent on sleep education was about 2.5 hours.³ Additionally, more than a quarter of medical schools surveyed did not provide any dedicated sleep instruction at all.³ There is no evidence of substantial improvement in recent years. A 2024 U.S. study of third-year medical students found that 88% had never received any formal sleep education.⁴

  This lack of training has downstream consequences: sleep is not integrated into routine primary care. Most clinicians fail to routinely screen for sleep health disorders when clinically assessing new patients.⁵ There is a severe shortfall in specialist care, too. In the U.S., there is just one board-certified sleep doctor for every 43,000 people.⁶

• Systemic inertia: Policy, funding, reimbursement

  Beyond education, systemic inertia continues to hold sleep back. Despite clear evidence that sleep is as vital as nutrition and physical activity, it is often left out of national public health agendas.⁷ This omission means healthy sleep tends to be excluded from major health strategies and funding streams.⁸

  The American Academy of Sleep Medicine (AASM) has identified persistent misalignment between payer policies and clinical guidelines, resulting in barriers to evidence-based care for patients with sleep disorders.⁹ Other studies also re-affirm that insurance coverage for sleep disorder diagnostics and therapies is inconsistent and often out of step with clinical best practices.¹⁰ For example, some payers require cumbersome diagnoses and therapy initiation procedures. Some payers also refuse to cover PAP therapy for OSA, while others that do cover it set strict constraints around it, limiting patient access to care.¹⁰

• Public perception and behaviors

  Public understanding of sleep health also lags. Conversations around sleep are often dominated by personal wellness advice—reducing blue light exposure or taking melatonin supplements, for example. While these behaviors may help sleep quality, they are insufficient on their own. They do not address the underlying causes or broader health impacts of common clinical sleep disorders like OSA and chronic insomnia.

  Without more widespread, effective education about the medical side of sleep health, millions of people will remain unaware that their struggles with sleep may be part of a serious, treatable condition.

Why sleep health matters

• Societal and clinical stakes

  Poor sleep is more than just a nuisance—it is a significant risk factor for disease and death. Many studies have established that regular poor sleep is a risk factor for all-cause mortality.² Poor sleep also undermines cardiovascular health, increases the risk of diabetes and depression, and reduces workplace productivity.

  Insomnia and OSA, for instance, are the two most prevalent sleep disorders, each affecting 10% to 30% of people.¹¹

  The clinical consequences of untreated OSA are severe. Individuals with untreated OSA are two to three times more likely to develop high blood pressure and the condition is linked to a range of cardiovascular complications like heart failure, stroke and coronary artery disease.^{12, 13}

  Despite this, up to 80–90% of OSA cases go undiagnosed, leaving millions at risk for serious health complications.¹⁴

  For insomnia, many studies indicate that people who do not get enough sleep or experience frequent sleep disturbances are at a higher risk of developing chronic non-communicable diseases such as cardiovascular disorders, such as coronary artery disease (CAD), heart attack, stroke, high blood pressure and diabetes.¹⁵

The impact of poor sleep on mental health is equally profound. Sleep disorders like insomnia and obstructive sleep apnea (OSA) are strongly linked to depression and anxiety. People with insomnia are over two times more likely to develop depression, and OSA is also associated with higher rates of mood disorders.^16,17

The economic burden of ignoring sleep

The economic costs of untreated sleep disorders are staggering:

• An AASM-commissioned report estimates that undiagnosed OSA costs the U.S. alone about $149.6 billion annually.¹⁸
• Up to 15% of adults suffer from chronic insomnia, costing 45–54 lost workdays per person annually in high-income countries.^19,20
• A separate study estimates the total annual cost of insomnia in the U.S. to be between $150.4 billion and $174.9 billion (in 2016 USD).²¹
• Focusing only on direct healthcare spending, sleep disorders cost the U.S. $94.9 billion each year.²²

The stakes: More than just feeling tired

Poor sleep doesn’t exist in a vacuum but rather weakens every other pillar of health. And we must know that as the global population ages, the burden of chronic disease rises and the costs of overlooking sleep will only grow. If left unaddressed, sleep disorders will continue to drain lives, strain systems and undermine efforts to improve public health at scale.

A call to action

If sleep is as essential as blood pressure, diet, or physical activity, why aren’t we treating it that way?

We need decisive action:

• Policymakers must elevate sleep in national health plans and prevention strategies, create targeted policy measures and fund research at a scale that matches its health impact. Sleep should be treated—and promoted—as equally essential to public health as nutrition and physical activity.
• Payors must bring reimbursement policies in line with clinical guidelines, removing barriers to diagnostics and treatment.
• Medical educators must integrate comprehensive sleep training throughout medical school and residency.
• Healthcare providers must routinely assess and screen for sleep issues as part of standard care.
• The public must move beyond wellness trends and demand access to real, evidence-based sleep solutions. Greater awareness of sleep disorders and their impact, through public health campaigns in schools, workplaces and digital media, can support earlier recognition and intervention.

Healthy sleep is essential—not optional. Let’s start treating it that way!