According to The Guardian, a new study shows that the quality of Americans’ sleep can vary depending on region.

The survey included 432,000 people and asked them: “During the past 30 days, for about how many days have you felt you did not get enough rest or sleep?”

Those who cited poor sleep on fewer than 15 days were placed in one group, and those who slept poorly on 15 or more days were placed in another. The study said: “The cutoff of 15 days was chosen to mirror the diagnostic criteria for insomnia.” It said that symptoms are “clinically relevant” if they exist for approximately half of a given stretch of nights.

The responses were divided up by county, to establish the prevalence of insufficient sleep at the county level. These estimates were evaluated to discern areas that have unusually high or low sleep levels, the so-called “hotspots” and “coldspots”.

The counties with the highest levels of insufficient sleep were at the intersection of Kentucky, Tennessee, West Virginia and Virginia. More than half of the counties that were deemed “hotspots” fell within that region. The study lists its “most important limitation” as its inability to “explore reasons for this geographic variation”. Ohio, Texas, and Missouri also saw high numbers of “hotspots”.

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