46. Michigan
> Pct. of adults getting insufficient sleep: 38.7%
> Avg. number of poor mental health days (per month): 4.1 (8th highest)
> Pct. of adults with heart disease: 5.4% (7th highest)
> Pct. of adults who are physically active: 74.5% (12th lowest)
> Personal income (per capita): $40,556 (15th lowest)
> Unemployment rate: 7.3% (5th highest)

An increased risk of heart disease is closely linked to sleep deprivation. In Michigan, one of the most sleep deprived states in the country, 5.4% of adults have heart disease, a larger share than in all but a handful of other states.

47. Alabama
> Pct. of adults getting insufficient sleep: 38.8%
> Avg. number of poor mental health days (per month): 4.6 (2nd highest)
> Pct. of adults with heart disease: 5.6% (5th highest)
> Pct. of adults who are physically active: 72.4% (8th lowest)
> Personal income (per capita): $37,493 (4th lowest)
> Unemployment rate: 6.8% (10th highest)

In few states is the relationship between a lack of sleep and poor health outcomes more apparent. Alabama has one of worst rates of adequate sleep among adults in the country, and it is also among the worst five in the country in many health problems commonly associated with insufficient sleep, including high blood pressure, heart disease, and stroke.

48. Maryland
> Pct. of adults getting insufficient sleep: 38.9%
> Avg. number of poor mental health days (per month): 3.3 (15th lowest)
> Pct. of adults with heart disease: 3.2% (4th lowest)
> Pct. of adults who are physically active: 78.6% (20th highest)
> Personal income (per capita): $55,143 (5th highest)
> Unemployment rate: 5.8% (24th lowest)

Despite having one of the highest shares of adults who do not get sufficient sleep, Maryland fares much better than most other states in health conditions that can be induced by inadequate sleep. Only 3.2% of adults have heart disease, and 3.1% of adults have reported suffering a heart attack, each one of the lowest shares in the country.

49. Kentucky
> Pct. of adults getting insufficient sleep: 39.7%
> Avg. number of poor mental health days (per month): 4.5 (4th highest)
> Pct. of adults with heart disease: 6.0% (4th highest)
> Pct. of adults who are physically active: 71.8% (6th lowest)
> Personal income (per capita): $37,654 (7th lowest)
> Unemployment rate: 6.5% (15th highest)

Nearly 40% of Kentucky’s population does not get enough sleep every night. This may help explain why the state has extremely high rates of nearly every common life-threatening condition associated with a lack of sleep, including heart disease, high blood pressure, diabetes, and heart attacks.

50. Hawaii
> Pct. of adults getting insufficient sleep: 43.9%
> Avg. number of poor mental health days (per month): 2.7 (2nd lowest)
> Pct. of adults with heart disease: 3.4% (6th lowest)
> Pct. of adults who are physically active: 80.4% (9th highest)
> Personal income (per capita): $46,396 (20th highest)
> Unemployment rate: 4.4% (10th lowest)

Nearly 44% of adults in Hawaii do not get adequate sleep, far and away the highest share in the country. Despite pervasive unhealthy sleep patterns, Hawaiians do relatively well in several related health measures. The link between cardiovascular health and sleep is well established, yet only 3.1% of adults in the state report having had a heart attack, one of the smallest shares in the country. Also, there are only 203 cardiovascular deaths per 100,000 people annually compared to the national rate of 251 deaths per 100,000 people.