Key takeaways
- The American Heart Association’s Life’s Essential 8 score gives full sleep points for 7 to 9 hours a night and takes points away for both shorter and longer sleep23.
- In a British study of 7,959 adults, people who slept six hours or less at ages 50, 60 and 70 had about a 30% higher risk of dementia than seven-hour sleepers, a link that doesn’t prove cause4.
- In a Mayo Clinic study published in 2025, 14% of older adults with chronic insomnia developed memory and thinking problems over about six years, versus 10% without it6.
- In a UCLA trial, older adults with insomnia who got cognitive behavioral therapy for insomnia (CBT-I) were about half as likely to develop major depression over three years as those who got sleep education7.
- In population surveys, 86% to 95% of people with significant sleep apnea had never been diagnosed, so loud snoring, gasping and daytime sleepiness deserve a checkup12.
When the American Heart Association (AHA) built its first heart-health checklist in 2010, sleep was left off. The reason was practical. Experts couldn’t agree on how to score it, because big national health surveys didn’t track it1.
By 2022, they did. That June, an AHA panel led by Donald Lloyd-Jones, then the group’s president, published Life’s Essential 8 in the journal Circulation12. Sleep joined diet, physical activity, nicotine, weight, cholesterol, blood sugar and blood pressure12.
Lloyd-Jones explained the change by noting that sleep shapes the other seven measures, too1. Poor sleep is also tied to poor mental health, which itself feeds heart disease1.
That makes sleep a prevention habit, not just a comfort. This article puts it in your prevention plan: how the heart score grades sleep, what newer studies say short sleep and insomnia predict, and which sleep problems to bring to a clinician. Our sleep section covers each problem in depth.
How the heart score grades your sleep
Life’s Essential 8 scores each of its eight measures from 0 to 100, then averages them2. An overall score of 80 or more counts as high, 50 to 79 as moderate and below 50 as low or poor2.
Sleep is scored by your average hours per night2. We walk through how the points work, as reprinted in a 2023 study in Frontiers in Cardiovascular Medicine3:
| Average sleep per night | Sleep points |
|---|---|
| 7 to under 9 hours | 100 |
| 9 to under 10 hours | 90 |
| 6 to under 7 hours | 70 |
| 5 to under 6 hours, or 10 hours or more | 40 |
| 4 to under 5 hours | 20 |
| Under 4 hours | 0 |
Two things stand out. First, a six-and-a-half-hour sleeper loses 30 points, a bigger hit than many people expect. Second, more isn’t always better: averaging 10 hours or more scores the same as five to six hours3.
That reflects the research. Both too much and too little sleep are linked with heart disease, the AHA says1. Long sleep may signal another health problem rather than cause one, as our article on individual sleep needs explains.
In national survey data from 2005 to 2016, U.S. adults averaged about 81 out of 100 on the sleep measure3. Our article on getting started in natural health shows how adults score on all eight. Children have their own targets, from 10 to 16 hours a day for children 5 and younger to 8 to 10 hours for teens2.
Short sleep in midlife tracked with dementia decades later
The heart score treats sleep as a heart issue. A long British study suggests it may matter for the brain, too.
The Whitehall II study has followed British civil servants since the 1980s5. Researchers at University College London (UCL) and France’s national health research institute, INSERM, used sleep reports that 7,959 participants gave six times between 1985–1988 and 2015–20164. Dementia diagnoses were tracked through 20194.
Over that time, 521 people were diagnosed with dementia, about 7 in 100 by our math4. People who reported six hours or less at ages 50, 60 and 70 had about a 30% higher risk than people who slept seven hours4. Sleeping eight hours or more showed no clear link4.
The link held after the team accounted for mental health, heart health, habits and social and economic factors4. The National Institute on Aging was among the funders4.
Outside experts urged caution. Sleep was mostly self-reported, and the civil servants didn’t mirror the whole British population, Sara Imarisio of Alzheimer’s Research UK noted5. Robert Howard of UCL pointed out that the link at age 50 only just reached statistical significance, and that poor sleep can be an early symptom of the disease rather than a cause5.
Howard added that people with insomnia shouldn’t assume they’re headed for dementia5. The study’s lead author also said the team couldn’t confirm that short sleep raises the risk4. What it does show is a long-range signal worth taking seriously.
Insomnia that lasts tracked with faster brain aging
Short sleep is one problem. Chronic insomnia is another: trouble sleeping at least three times a week, lasting three months or longer6.
In a study published in September 2025 in the journal Neurology, Mayo Clinic researchers followed 2,750 older adults with normal thinking, average age 70, for about 5.6 years6. About 16% had chronic insomnia in their medical records6.
By the end, 14% of those with insomnia had developed mild cognitive impairment, an early stage of memory and thinking problems, or dementia. Among people without insomnia, 10% had6. After the team accounted for age, high blood pressure, sleep apnea and sleeping-pill use, insomnia carried a 40% higher risk, roughly equal to 3.5 extra years of aging6.
People who said they’d been sleeping less than usual also showed more amyloid, the protein that builds up in Alzheimer’s disease, and more signs of small-vessel damage on brain scans6.
Again, this is a link, not proof. Diagnoses from medical records miss people whose insomnia was never recorded6. The work was funded by the National Institutes of Health, two foundations and a grant from Sleep Number, the mattress company, to Mayo Clinic6.
Treating insomnia halved new bouts of depression in one trial
Observational studies can’t tell you whether fixing sleep prevents disease. A trial can, and one UCLA trial did test that for depression.
UCLA researcher Michael Irwin’s team enrolled 291 adults aged 60 and older who had insomnia but no depression in the past year78. Their average age was 707. About half got CBT-I, a structured program that retrains sleep habits and thoughts about sleep. The rest got sleep education, a comparison class taught in the same group format78.
Both programs met weekly in two-hour groups for two months8. Then the researchers checked for depression every month for three years8.
In the CBT-I group, 12.2% developed major depression. In the sleep-education group, 25.9% did7. By our math, that’s about 14 fewer cases per 100 people treated, or roughly one case prevented for every seven people who took CBT-I7. People whose insomnia stayed in remission had the lowest risk of all7.
The trial had limits. Nearly everyone finished treatment, but only about half completed the three-year check, and the authors called for studies in more diverse groups7. Results were published in JAMA Psychiatry in 20217.
CBT-I is already the first treatment the American College of Physicians recommends for every adult with chronic insomnia, a strong recommendation it made in 2016910. Our article on chronic insomnia explains how the program works and how to start.
Sleep problems feed the other risk factors
Sleep doesn’t act alone. It pushes on the risk factors that the rest of a prevention plan targets. Our articles on sleep and metabolism and on insufficient sleep cover the trials on blood sugar, appetite and attention.
Sleep apnea links them most directly. In obstructive sleep apnea, the throat repeatedly narrows or closes during sleep, dropping oxygen levels and breaking up sleep11.
A 2021 AHA scientific statement estimated that about 34% of middle-aged men and 17% of middle-aged women meet the criteria for it11. Among people with high blood pressure, heart failure, coronary artery disease, atrial fibrillation or stroke, it affects 40% to 80%11.
Most people with it don’t know. In population surveys, 86% to 95% of people with significant sleep apnea had never been diagnosed, and missed diagnoses were especially common among Black patients12.
The AHA statement recommends screening for sleep apnea in people whose blood pressure stays high despite treatment and in people whose atrial fibrillation returns after treatment11. A later article in this series covers blood pressure, and our sleep apnea article covers testing and treatment.
For older adults, sleeping pills carry their own risks
When sleep goes wrong, a pill can look like the simplest fix. For older adults, the American Geriatrics Society’s 2023 Beers Criteria, a list of medicines that are often a poor choice in later life, says otherwise13.
The list says to avoid benzodiazepines, a class of sedatives, when possible. Older bodies clear them more slowly, and they raise the risk of confusion, memory problems, falls, fractures and car crashes13. The same concerns apply to “Z-drugs,” newer prescription sleeping pills13. Our sleep-aid article covers the drugstore antihistamines on the same list.
The American College of Physicians adds that the FDA approved sleeping pills for short-term use9. Its guideline notes that observational studies link them to rare but serious harms, including dementia, fractures and injuries10.
If you take a sleeping pill now, don’t change it on your own. Bring the bottle to your clinician and talk through the options, including CBT-I913.
What the evidence shows
| Claim | Evidence level | What it rests on |
|---|---|---|
| CBT-I treats chronic insomnia in adults, including older adults | ACP guideline review of trials10 | |
| Treating insomnia with CBT-I prevents depression in older adults | One three-year trial of 291 people78 | |
| Persistent short sleep in midlife raises dementia risk | Large observational study; cause unproven45 | |
| Chronic insomnia speeds brain aging | Observational study; diagnoses from records6 | |
| Sleep apnea is common and mostly undiagnosed | AHA statement and population surveys1112 | |
| Benzodiazepines and Z-drugs carry fall and memory risks in older adults | Beers Criteria and ACP review1013 | |
| Sleeping 9 or more hours protects health | Heart score docks points; no benefit for 8+ hours in Whitehall II34 |
Sleep in your prevention plan
This plan is our own, built from the research above. Find the signals that fit you, then take the first step.
| Signal | What it may raise risk for | First step | Read next |
|---|---|---|---|
| You average under 7 hours | Lower heart score; dementia link with persistent short sleep34 | Protect a 7-hour window for two weeks | Our article on individual sleep needs |
| Your bed and wake times swing by hours | Body-clock disruption | Fix your wake-up time first | Our article on sleep schedules |
| Loud snoring, gasping or snorting, daytime dozing | Sleep apnea, tied to heart disease1112 | Ask your clinician about a sleep evaluation | Our sleep apnea article |
| Trouble sleeping 3 or more times a week for 3 months | Chronic insomnia, tied to memory decline and depression67 | Ask about CBT-I9 | Our chronic insomnia article |
| You take a sleeping pill most nights | Falls, confusion and crashes in older adults13 | Review it with your clinician9 | Our sleep-aid article |
| You work nights or rotating shifts | Body-clock strain | Anchor a main sleep block | Our articles on irregular schedules and shift work disorder |
The oldest natural remedy needs no prescription
Many natural-health readers already treat sleep as medicine. The research backs that instinct. The best-tested fix for chronic insomnia is a skills program, not a product10.
CBT-I fits values of self-reliance: you learn the skills, and they stay with you. It doesn’t depend on a supplement or a gadget, and it doesn’t compete with medical care. It is medical care.
The same scrutiny applies to every seller. A mattress company helped fund one of the studies above6. That doesn’t make the findings wrong, but it’s worth knowing who pays.
Questions readers ask
Is six hours really a problem if I feel fine?
It can be. The heart score gives 70 of 100 points for six to seven hours3. In the Whitehall II study, persistent short sleep across midlife tracked with more dementia, though that’s a link, not proof4. Our article on individual sleep needs explains how to test your own number.
Will sleeping more lower my dementia risk?
No one has shown that yet. The dementia studies above are observational, and poor sleep may be an early sign of disease rather than a cause5. The strongest trial evidence for treating sleep so far is about preventing depression, not dementia7.
If short sleep is bad, is 10 hours better?
No. The heart score gives 10 or more hours the same 40 points as five to six hours3. Whitehall II found no protective effect for eight or more hours4.
Do I need a sleep tracker to get my score?
No. The score uses your average hours per night, which you can estimate with a simple sleep diary2. Our article on sleep trackers covers what the devices measure well and what they don’t.
The bottom line
Sleep now sits on the same prevention checklist as diet and blood pressure, and for good reason. Short sleep and lasting insomnia track with heart disease, depression and memory decline, and sleep apnea hides in most people who have it.
The proof that fixing sleep prevents disease is still thin, but one trial found that CBT-I halved new bouts of depression in older adults. Aim for 7 to 9 hours, take snoring and long-running insomnia to a clinician, and treat skills, not pills, as the first tool.
Related reading
About this article
This article was researched using American Heart Association and American College of Physicians guidance, peer-reviewed studies, university and medical-society news releases, and independent expert commentary, all listed below. It was reviewed in October 2026. It is general education, not medical, legal or financial advice.
Sources
- American Heart Association News. “Sleep joins revamped list of heart health essentials.” June 29, 2022. heart.org
- American Heart Association. News release on Lloyd-Jones DM, et al., “Life’s Essential 8: Updating and Enhancing the American Heart Association’s Construct of Cardiovascular Health: A Presidential Advisory From the American Heart Association,” Circulation, 2022. ScienceDaily, June 29, 2022. sciencedaily.com
- Zheng Y, Huang T, Guasch-Ferre M, et al. “Estimation of life’s essential 8 score with incomplete data of individual metrics.” Frontiers in Cardiovascular Medicine, 2023. frontiersin.org
- University College London. “Lack of sleep in middle age linked to dementia risk” (on Sabia S, et al., “Association of sleep duration in middle and old age with incidence of dementia,” Nature Communications, 2021). UCL News, April 2021. ucl.ac.uk
- Science Media Centre. “Expert reaction to study looking at sleep duration and dementia risk.” April 20, 2021. sciencemediacentre.org
- American Academy of Neurology. Press release on Carvalho DZ, et al., chronic insomnia, cognitive decline and brain aging, Neurology, September 10, 2025. aan.com
- NeurologyLive. “Insomnia Treatment May Prevent Depression in Older Adults” (on Irwin MR, et al., “Prevention of incident and recurrent major depression in older adults with insomnia,” JAMA Psychiatry, 2021). November 30, 2021. neurologylive.com
- Psychiatric News Alert (American Psychiatric Association). “Cognitive Behavioral Therapy for Insomnia Prevents Depression in Older Adults.” November 24, 2021. alert.psychnews.org
- American College of Physicians. “ACP Recommends Cognitive Behavioral Therapy as Initial Treatment for Chronic Insomnia.” News release, May 3, 2016. acponline.org
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. “Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians.” Annals of Internal Medicine, 2016. pubmed.ncbi.nlm.nih.gov
- American College of Cardiology. “Obstructive Sleep Apnea and CV Disease: AHA Statement — Ten Points to Remember” (on Yeghiazarians Y, Jneid H, Tietjens JR, et al., Circulation, 2021). June 25, 2021. acc.org
- ACP Internist Weekly (American College of Physicians). “Screen cardiovascular disease patients for sleep apnea, AHA recommends.” June 29, 2021. immattersacp.org
- Skolnik N. “What not to prescribe older adults and what to use instead” (on the 2023 American Geriatrics Society Beers Criteria, Journal of the American Geriatrics Society, 2023). The Hospitalist, November 2023. community.the-hospitalist.org