Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis

Abstract

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including ≥100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1–100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40–69 years, 55.5% female) from the United Kingdom and 409,617 people (≥18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the ‘acceptable’ sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8–10 h and 18% report daytime sleepiness. In adults (≥18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6–19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending ≥9 h in bed, whereas poor sleep quality was more frequent in those spending <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5–2.9 times higher in the United States. Women (≥41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1: Age-specific percentile curves of TST (n = 164,069) and SE (n = 76,746).
Fig. 2: Age-specific percentile curves for TIB, stratified by sex (n = 106,282, 56% females).
Fig. 3: Sleep timing across lifespan.
Fig. 4: Prevalence of having difficulty initiating sleep (n = 95,603) and ‘poor’ sleep quality (n = 77,854), across different durations of time in bed.

Data availability

Our data protection agreements with the participating cohort studies do not allow us to share individual-level data from these studies to third parties.

Code availability

The coding protocol for data analysis is provided in the Supplementary Text. Scripts of the statistical analyses are available upon request.

References

  1. 1.

    Morin, C. M. et al. Cognitive-behavior therapy singly and combined with medication for persistent insomnia: impact on psychological and daytime functioning. Behav. Res. Ther. 87, 109–116 (2016).

    Article  Google Scholar 

  2. 2.

    van Straten, A. et al. Cognitive and behavioral therapies in the treatment of insomnia: a meta-analysis. Sleep Med. Rev. 38, 3–16 (2018).

    Article  Google Scholar 

  3. 3.

    Hirshkowitz, M. et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health 1, 233–243 (2015).

    Article  Google Scholar 

  4. 4.

    Hirshkowitz, M. et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health 1, 40–43 (2015).

    Article  Google Scholar 

  5. 5.

    Guyatt, G. H. et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Brit. Med. J. 336, 924–926 (2008).

    Article  Google Scholar 

  6. 6.

    Walch, O. J., Cochran, A. & Forger, D. B. A global quantification of “normal” sleep schedules using smartphone data. Sci. Adv. 2, e1501705 (2016).

  7. 7.

    Kerkhof, G. A. Epidemiology of sleep and sleep disorders in The Netherlands. Sleep Med. 30, 229–239 (2017).

    Article  Google Scholar 

  8. 8.

    Soldatos, C. R., Allaert, F. A., Ohta, T. & Dikeos, D. G. How do individuals sleep around the world? Results from a single-day survey in ten countries. Sleep Med. 6, 5–13 (2005).

    Article  Google Scholar 

  9. 9.

    Iglowstein, I., Jenni, O. G., Molinari, L. & Largo, R. H. Sleep duration from infancy to adolescence: reference values and generational trends. Pediatrics 111, 302–307 (2003).

    Article  Google Scholar 

  10. 10.

    Hense, S. et al. Factors that influence weekday sleep duration in European children. Sleep 34, 633–639 (2011).

    Article  Google Scholar 

  11. 11.

    Leng, Y. et al. Self-reported sleep patterns in a British population cohort. Sleep Med. 15, 295–302 (2014).

    Article  Google Scholar 

  12. 12.

    Espiritu, J. R. Aging-related sleep changes. Clin. Geriatr. Med. 24, 1–14 (2008).

    Article  Google Scholar 

  13. 13.

    Jackson, C. L., Redline, S., Kawachi, I., Williams, M. A. & Hu, F. B. Racial disparities in short sleep duration by occupation and industry. Am. J. Epidemiol. 178, 1442–1451 (2013).

    Article  Google Scholar 

  14. 14.

    Ohayon, M. M. & Reynolds, C. F. 3rd Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD). Sleep Med. 10, 952–960 (2009).

    Article  Google Scholar 

  15. 15.

    Roth, T. et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: results from the America Insomnia Survey. Biol. Psychiatry 69, 592–600 (2011).

    Article  Google Scholar 

  16. 16.

    Galland, B. C., Taylor, B. J., Elder, D. E. & Herbison, P. Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Med. Rev. 16, 213–222 (2012).

    Article  Google Scholar 

  17. 17.

    Ohayon, M. M., Carskadon, M. A., Guilleminault, C. & Vitiello, M. V. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27, 1255–1273 (2004).

    Article  Google Scholar 

  18. 18.

    Olds, T., Blunden, S., Petkov, J. & Forchino, F. The relationships between sex, age, geography and time in bed in adolescents: a meta-analysis of data from 23 countries. Sleep Med. Rev. 14, 371–378 (2010).

    Article  Google Scholar 

  19. 19.

    Simonelli, G. et al. Sleep health epidemiology in low and middle-income countries: a systematic review and meta-analysis of the prevalence of poor sleep quality and sleep duration. Sleep Health 4, 239–250 (2018).

    Article  Google Scholar 

  20. 20.

    Dutch Census 2011 (Statistics Netherlands, 2014).

  21. 21.

    Bianchi, M. T., Thomas, R. J. & Westover, M. B. An open request to epidemiologists: please stop querying self-reported sleep duration. Sleep Med. 35, 92–93 (2017).

    Article  Google Scholar 

  22. 22.

    Lavie, P. Self-reported sleep duration—what does it mean? J. Sleep Res. 18, 385–386 (2009).

    Article  Google Scholar 

  23. 23.

    Hayley, A. C. et al. Trajectories and stability of self-reported short sleep duration from adolescence to adulthood. J. Sleep Res. 24, 621–628 (2015).

    Article  Google Scholar 

  24. 24.

    Sivertsen, B., Harvey, A. G., Pallesen, S. & Hysing, M. Trajectories of sleep problems from childhood to adolescence: a population-based longitudinal study from Norway. J. Sleep Res. 26, 55–63 (2017).

    Article  Google Scholar 

  25. 25.

    Sleep and Sleep Disorders: Data and Statistics (CDC, 2014).

  26. 26.

    Sheehan, C. M., Frochen, S. E., Walsemann, K. M. & Ailshire, J. A. Are U.S. adults reporting less sleep? Findings from sleep duration trends in the National Health Interview Survey, 2004–2017. Sleep 42, zsy221 (2019).

  27. 27.

    Hoevenaar-Blom, M. P., Spijkerman, A. M., Kromhout, D., van den Berg, J. F. & Verschuren, W. M. Sleep duration and sleep quality in relation to 12-year cardiovascular disease incidence: the MORGEN study. Sleep 34, 1487–1492 (2011).

    Article  Google Scholar 

  28. 28.

    Anujuo, K. et al. Relationship between short sleep duration and cardiovascular risk factors in a multi-ethnic cohort—the HELIUS study. Sleep Med. 16, 1482–1488 (2015).

    Article  Google Scholar 

  29. 29.

    Cappuccio, F. P., Cooper, D., D’Elia, L., Strazzullo, P. & Miller, M. A. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur. Heart J. 32, 1484–1492 (2011).

    Article  Google Scholar 

  30. 30.

    Cappuccio, F. P., D’Elia, L., Strazzullo, P. & Miller, M. A. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 33, 414–420 (2010).

    Article  Google Scholar 

  31. 31.

    Adjei, N. K. & Brand, T. Investigating the associations between productive housework activities, sleep hours and self-reported health among elderly men and women in Western industrialised countries. BMC Public Health 18, 110 (2018).

    Article  Google Scholar 

  32. 32.

    Williams, J. A., Zimmerman, F. J. & Bell, J. F. Norms and trends of sleep time among US children and adolescents. JAMA Pediatr. 167, 55–60 (2013).

    Article  Google Scholar 

  33. 33.

    Ohayon, M. M. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med. Rev. 6, 97–111 (2002).

    Article  Google Scholar 

  34. 34.

    Itani, O. et al. Nationwide epidemiological study of insomnia in Japan. Sleep Med. 25, 130–138 (2016).

    Article  Google Scholar 

  35. 35.

    Stewart, L. A. et al. Preferred reporting items for systematic review and meta-analyses of individual participant data: the PRISMA-IPD statement. JAMA 313, 1657–1665 (2015).

    Article  Google Scholar 

  36. 36.

    The Dutch Standard Classification of Education SOI 2006 (Statistics Netherlands, 2008).

  37. 37.

    Statistics Netherlands. Wat verstaat het CBS onder een allochtoon? (2016); https://www.cbs.nl/nl-nl/faq/specifiek/wat-verstaat-het-cbs-onder-een-allochtoon-#

  38. 38.

    Diagnostic and Statistical Manual of Mental Disorders 5th edn (APA, 2013).

  39. 39.

    Stronks, K., Kulu-Glasgow, I. & Agyemang, C. The utility of ‘country of birth’ for the classification of ethnic groups in health research: the Dutch experience. Ethn. Health 14, 255–269 (2009).

    Article  Google Scholar 

  40. 40.

    Koopman-Verhoeff, M. E. et al. Preschool family irregularity and the development of sleep problems in childhood: a longitudinal study. J. Child Psychol. Psychiatry 60, 857–865 (2019).

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    Koolhaas, C. M. et al. Objectively measured sleep and body mass index: a prospective bidirectional study in middle-aged and older adults. Sleep Med. 57, 43–50 (2019).

    Article  Google Scholar 

  42. 42.

    Jones, S. E. et al. Genetic studies of accelerometer-based sleep measures yield new insights into human sleep behaviour. Nat. Commun. 10, 1585 (2019).

    Article  Google Scholar 

Download references

Acknowledgements

This research has been conducted using the UK Biobank Resource (UKBB application nos. 6818 and 9072). We would like to thank the participants and researchers from the UKBB who contributed or collected data. This work was supported by a grant financed by the Dutch Brain Foundation (Hersenstichting, grant no. GH2015.4.01). The work of D.K. was supported by an NWA Startimuls KNAW 2017 grant no. AZ/3137. E.J.W.V.S. was supported by European Research Council grant no. ERC-2014-AdG-671084 INSOMNIA. The work of H.T. was supported by a Netherlands Organization for Scientific Research grant no. 017.VICI.106.370. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Affiliations

Authors

Contributions

D.K., H.T. and E.J.W.V.S. designed the study and, together with T.S.L. and A.I.L., worked on establishing definitions, and obtaining contact with the included cohorts and drafting the manuscript. O.H.F. provided expertise in systematic reviewing and meta-analysis. W.M.B. provided systematic literature reviewing of online databases expertise. D.K., T.S.L., I.P.M.D., M.E.K.-V. and Y.X. independently screened abstracts identified by systematic review. D.K., T.S.L., M.P.C.M.L. and A.I.L. closely monitored data coding and ensured reliability. D.K. and T.S.L. independently coded all individual datasets and D.K. analysed the data. A.D., N.A., N.R.B., A.B., J.B., W.J.B., H.C.C., E.C., H.S.D., E.J.d.B., R.d.G., J.F.D.-K., P.J.M.E., R.J.B.J.G., L.G., L.H., C.A.H., C.J.H., M.H., A.H., M.A.I., S.E.J., M.K.V., M.K., A.M.M., K.M., R.M., A.J.O., J.O.G., B.W.J.H.P., H.S.J.P., S.P., S.A.R., E.R., C.M.R., G.R., F.R., M.C.S., A.S.S., M.B.S., K.S., M.t.H., J.W.R.T., D.v.d.M., J.v.d.E., K.B.v.d.H., P.G.v.d.V., F.J.v.L., R.R.L.v.L., S.H.v.O., F.J.v.S., C.M.S., R.A.V., F.C.V., M.C.M.V., R.C.H.V., W.M.M.V., T.G.M.V., A.H.W., A.M.W., M.t.W. and A.R.W. were involved in the design, data collection or management of the individual studies and provided important insight into the respective datasets and their coding, cleaning and usage. All authors critically evaluated the manuscript and approved the last version.

Corresponding author

Correspondence to Henning Tiemeier.

Ethics declarations

Competing interests

All authors have completed the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form and declare: no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Additional information

Peer review information Peer reviewer reports are available. Primary Handling Editor: Jamie Horder.

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Supplementary Information

Supplementary Text, Supplementary References, Supplementary Figs. 1–7 and Supplementary Tables 1–16.

Reporting Summary

Peer Review Information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kocevska, D., Lysen, T.S., Dotinga, A. et al. Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis. Nat Hum Behav 5, 113–122 (2021). https://doi.org/10.1038/s41562-020-00965-x

Download citation

Further reading

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing