Nearly 1 in 5 West Virginians said they didn't get a single good night's sleep in the previous month. The national average was about 1 in 10, according to the federal health survey conducted last year.
Tennessee, Kentucky and Oklahoma also were notably above average in their reported lack of sleep. In contrast, North Dakota had fewer problems sleeping, with only 1 in 13 reporting that degree of sleeplessness.
Health officials do not know the exact reasons for the differences.
"We didn't ask 'Why didn't you get enough rest or sleep?"' said Lela McKnight-Eily, a U.S. Centers for Disease Control and Prevention epidemiologist who led the study.
But experts noted several possible explanations. West Virginia ranks at or near the bottom of the nation in a variety of health measures, including obesity, smoking, heart disease and the proportion of adults with disabilities. Studies have increasingly found sleeping problems in people with certain health problems, including obesity.
"You would expect to see poorer sleep within a chronically diseased population," noted Darrel Drobnich of the National Sleep Foundation, a nonprofit advocacy and research organization.
Some experts believe sleep-deprived people are more inclined to eat more fatty foods during the day.
"There's growing evidence sleep deprivation promotes obesity," said Dr. Ronald Chervin, a University of Michigan sleep disorders expert.
Financial stress and odd-hour work shifts can play roles in sleeplessness, too, Chervin added. He suggested those may be contributing factors in West Virginia, an economically depressed state with tens of thousands of people working in coal mining.
The report is based on results of an annual telephone survey of more than 400,000 Americans, including at least 3,900 in each state. The survey did not include people who only use cell phones, CDC officials said.
The survey echoed earlier studies that found women are more likely to have sleeping problems than men, and blacks are more likely to get less sleep than whites or Hispanics.
The survey did not ask people how many hours of sleep they got, and different respondents may have had different views of what counted for a good night's sleep. Sleep experts recommend seven to nine hours of sleep each night.
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