Although sleep is vital to our well-being, as many as 35.1% of American adults fail to get at least seven hours of sleep each night — the minimum recommended sleep time for adults. Beyond feeling tired and less productive, a lack of sleep has more far-reaching implications — mostly to our health.

Research shows that not getting enough rest each night is associated with numerous physical and mental health problems. A lack of sleep can also lead to accidents in the workplace, fatal crashes on the road, and poor performance at work. The Centers for Disease Control and Prevention (CDC) surveyed American adults to find how many hours of sleep they get each day, on average. While nationally 35.1% of adults are sleep deprived, the problem varies significantly across states. In South Dakota, 28.4% fail to get enough sleep each night, while in Hawaii, 43.9% are sleep deprived.

The CDC has linked insufficient sleep with a number preventable diseases and conditions. Sleep deprivation has been shown to lead to an increased risk of diabetes, high blood pressure, heart disease, and obesity. These conditions tend to be less common in states where a larger share of adults are getting sufficient sleep.

Click here to see the which state residents get the most and least sleep.

Of the 26 states where a larger than average share of adults are getting adequate sleep, only four have a larger share than average share of adults with heart disease. Additionally, of the 26 states with better than average sleep habits, only seven have a larger than average share of adults with diabetes. Conversely, in 17 of the 24 states where adults are getting less sleep than adults nationwide, heart disease and diabetes are more common than they are across the country.

In addition to all the physical problems that are related to a lack of adequate rest, mental health is also closely tied to sleep. In the vast majority of states where relatively few adults are getting enough sleep, adults also report feeling in poor mental well-being more often than the average American.

It is also important to look at what can cause a lack of sleep. Many outside factors can induce stress, and these factors indeed tend to be more prevalent in states with poor sleeping habits. Financial security, for example, is important for mental well-being, and gainful employment is often essential to maintaining overall well-being. Each of the 10 states with the highest share of adults getting sufficient sleep also have among the lowest unemployment rates in the country.

Just as stressors can lead to inadequate sleep, a lack of sleep can lead to stress and depression. Often, this is a vicious cycle where stress causes less sleep, which can lead to an unhealthy mental state, which can induce further stress and less sleep.

While sleep is important to personal health, sleep deprivation also poses more immediate, and perhaps more obvious, risks to individuals and communities. According to the National Sleep Foundation, sleepiness can impair an individual’s ability to drive, in the same manner as alcohol. “[S]leepiness slows reaction time, decreases awareness, [and] impairs judgement” — factors that can increase the risk of an accident. The National Highway Traffic Safety Administration reports that roughly 846 fatalities on America’s roadways each year are attributable to drowsy driving. Similarly, for those working in dangerous occupations, drowsiness can increase the risk of a fatality on the job.

In order to determine the states getting the most (and least) sleep, 24/7 Wall St. reviewed data from the CDC on the percentage of adults by state reporting insufficient sleep, defined as less than seven hours per night. Other data, including personal income per capita, cardiovascular deaths, and physical activity were compiled by the United Health Foundation. Data on roadway deaths by state came from the Insurance Institute for Highway Safety. States were ranked from the smallest share of adults reporting insufficient sleep to the largest share. Unemployment rates are from the most recent annual comparable period.

These are the states getting the most (and least) sleep.