Sleep Hygiene and Mental Health THE RELATIONSHIP BETWEEN DISTURBED SLEEP AND SUICIDE

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The battle against suicide took a step backward between 2011 and 2012. According to the CDC, while 8 of the 10 most common causes of death in the US showed statistically significant reductions in the death rate over the span of merely 1 year, one cause of death among the top 10 showed a significant increase—suicide.1 More than 40,000 Americans will complete suicide this year. Clearly more needs to be understood and done to reverse these trends.

All psychiatrists know the risk factors for suicide. Some are unmodifiable, such as advancing age, male sex, and being white.

Others are potentially modifiable, such as depression, drug abuse, hopelessness, and social isolation. Among the newest modifiable risk factors to join the list are insomnia and nightmares.

Risk Factors

What explains these associations, especially when 2 seemingly opposite phenomena such as insomnia and hypersomnia are linked to suicide? One explanation is the simple concept of “burden of illness.” It is well known that a chronic medical illness is a risk factor for suicide, so perhaps the burden of living with insomnia or hypersomnia becomes the “straw that breaks the camel’s back.”

The strength of the association between sleep disturbance and suicide would suggest that many suicide deaths happen at night, yet the opposite seems to be the case.

Very few suicide deaths occur during the nighttime hours, followed by a sharp rise in suicide death rates through the morning hours and a decline again toward evening.

Therefore, if sleep disturbance is related to suicide, it may be through the effects of sleep disturbance on daytime psychological or physiological function.

Both insomnia and hypersomnia are associated with impairments in cognitive functioning. Patients with insomnia have trouble in problem solving, and deficits in problem solving have been described in persons who have survived suicide attempts. 

In this scenario, the person who is dealt a major setback, such as a broken relationship or job loss, is unable to produce a solution to the problem if he or she has insomnia; this leads to the worst possible solution. Hypersomnia, like insomnia, is also associated with deficits in cognition.

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