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Maryland is third-most sleep-deprived state in the U.S.

Some nights, the Rev. Emora T. Brannan just can't make himself go to bed. The self-proclaimed night owl browses the Internet, reads a book and even makes up an excuse to walk the dog — anything but go to sleep.

"I just have this urge of wanting to do things right around bedtime," said Brannan, a retired Methodist pastor who sometimes pays the price the next day when he wakes up groggy and not particularly well-rested.

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He has company. Maryland is the third-most sleep-deprived state — just behind Kentucky and Hawaii, according to a survey by the Centers for Disease Control and Prevention. About 61 percent of Marylanders get the recommended seven hours or more of sleep per night, compared to 65.2 percent across the country. More than a third of Americans don't get the recommended amount of sleep.

The CDC survey marks the first time the agency has studied sleep deprivation state by state.

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Anne Wheaton, one of the lead CDC researchers, said the data could help public health administrators better determine where to target funding for sleep research and treatment for all the ailments that arise from not getting enough shut-eye. Lack of sleep can contribute to a host of health problems, including obesity, diabetes, pulmonary distress and cardiovascular disease.

"It is important to have local level information, so public health officials know where health conditions are worse," Wheaton said, "so they know where to allocate resources."

The researchers used data from a 2014 national health survey the CDC does in conjunction with state health departments, called the Behavioral Risk Factor Surveillance System. As part of the survey, 444,306 patients answered health questions, including how many hours of sleep they typically got each night.

The best sleepers tended to be older, married and highly educated, according to the findings. For instance, 73.7 percent of people older than age 65 typically slept for more than seven hours a night, and 71.5 percent of those with a college or graduate degree got adequate sleep.

The worst sleepers were found in the southeastern United States and in states along the Appalachians. These areas also have higher rates of chronic health conditions such as obesity.

The study didn't delve deeply into why Maryland ranked so high, but local sleep specialists who see the problems every day said they were not surprised. Many factors contribute to the sleep-deprivation, including untraditional work shifts, overscheduled lives and problems dealing with stress.

For some people, lack of sleep has become a such a way of life that they don't even recognize that they are fatigued, sleep doctors said. People have learned to live tired.

"They will deny they are sleepy, but if you test them and do objective measures of sleepiness, you find that they are," said Dr. Marie Chatham, chief of pulmonary medicine at Greater Baltimore Medical Center in Towson. "You put them in a room and they fall asleep in two minutes. It takes the average person at least 10 minutes."

Dr. Naveed Shah, a pulmonary and sleep specialist at the LifeBridge Health Sleep Centers at Northwest Hospital, said technology such as smartphones makes it hard for some of his patients to wind down.

"In the past, people might watch a couple of television shows and then go to bed," Shah said. "Now people have this thing they can hold in their hand and take to bed with them."

Shah questioned whether the simple survey the CDC used was the best analysis of just how sleepy Americans are.

The CDC researchers acknowledged some of the study's limitations, including that it relied on self-reporting and was not corroborated by a more precise measurement, such as a more intensive sleep study. But Shah said the results are similar to those of other studies.

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Sleep specialists said there are proven ways to address sleep problems, including developing a consistent bedtime routine, sleeping on a regular schedule and avoiding screen time right before bed. They also suggest that people sleep in a dark room without the television on. In some cases, doctors can prescribe sleep drugs or a machine to help people breathe better while they sleep.

Even with these tips, fighting sleep deprivation can be hard for some people.

Brannan, the retired minister, said his sleep has improved vastly over the years. There was a time when he was constantly drowsy, sometimes falling asleep at red lights, only to be jolted awake when the other cars moved as the light turned green. After visiting a sleep doctor and undergoing tests, he was diagnosed with sleep apnea and prescribed a machine to help him breathe better. He now feels more refreshed when he wakes up in the morning.

Yet Brannan still struggles with getting enough sleep some days because he simply can't make himself go to bed at night.

"As long as I am compliant, I'm OK," Brannan said. "But that is not always the case."

Diane Perry has tried all the sleep tips as well, including keeping her room dark and the television off. But the 55-year-old pulmonary function technician and medical assistant still struggles to get a good night's rest.

When her head hits the pillow, her mind starts racing. She worries about paying bills, work and a thousand other things. Just the other night, she had trouble sleeping even after taking the prescription sleep aid Temazepam. She spent a lot of the night watching the clock, counting how many hours until it was time to get up.

"It is almost like my brain wakes up," Perry said. "I can be tired all day and it's like at night — boom — it wakes up."

"I hope to one day sleep through the night," she said. "An eight-hour night would be like a dream come true. I wouldn't believe it."

When people are sleepy, their reaction time is slower and their complex cognitive function may be impaired. Their attention span also may be slow.

The body doesn't recover from too little sleep as easily as some people may want.

"In the end you have to repay your sleep debt," Chatham said. "And like the bank you have to pay it back with interest. You can't do it all just by sleeping in on Saturday morning."

The CDC researchers and sleep doctors say there needs to be cultural shift in the way people think about sleep. Some people don't make it a priority and even think of going without sleep as an accomplishment or sign of strength.

"A lot of people consider a sleepless night a badge of honor," Wheaton said. "It is a sign that 'I am really working hard.' People need to make sleep one of their priorities."

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