We’ve all seen or heard the commercials, the ones about people desperately in need of a new mattress. Choose soft, choose firm, find your sleep number…so many seemingly simple solutions to the widespread absence of a good night’s rest. But the real reasons why Americans are tossing and turning at night is more than mattress deep, according to Sleep Management in the US: Consumer Strategies, a new report by market research firm Packaged Facts.

The truth is, troubled sleep is normal and for many Americans that realization is its own nightmare. Packaged Facts’ proprietary survey reveals that 82% of adults have trouble sleeping at least once a week, due to at least one of several forms of sleep disturbance. This translates to 206 million “troubled sleepers” out of 249 million US adults. But even frequent troubled sleep is commonplace, with 39% of adults having trouble sleeping five or more times a week. Likewise, more than a third of US adults have at least one of four major sleep disorders (insomnia, sleep apnea, restless legs syndrome or narcolepsy).

These disorders are costly to treat, with various reports estimating that the total cost of insomnia exceeds $100 billion annually, with the majority being spent on indirect costs such as poorer workplace performance, increased healthcare use, and increased accident risk. The annual economic cost of moderate-to-severe obstructive sleep apnea (OSA) and obstructive sleep apnea syndrome (OSAS) in the US is between $65 billion and $165 billion—greater than asthma, heart failure, stroke, and hypertensive disease, according a Harvard Medical School Division of Sleep Medicine study.

“The serious health and well-being consequences associated with sleep disturbance provide the need for treatment options that both address the condition and enhance quality of life—outcomes that walk together hand in hand, but that also often come at a costly expense,” says David Sprinkle, research director, Packaged Facts.

To promote optimal health and well-being, adults are recommended to sleep at least seven hours each night. Sleeping less than seven hours per night is associated with increased risk for obesity, diabetes, high blood pressure, coronary heart disease, stroke, frequent mental distress, and death.

While many adults achieve the recommended allowance of sleep, millions do not: Packaged Facts’ 2016 survey results show that some 56% of respondents “usually” sleep at least seven hours per night. This translates to 140 million adults who get at least seven hours of sleep—and 110 million who do not.  However, while quantity of sleep is clearly important, sleep disorders may be more closely associated with quality of sleep, notes the report.