Abstract
Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Agargun MY, Kara H, Solmaz M (1997) Sleep disturbances and suicidal behavior in patients with major depression. J Clin Psychiatry 58(6):249–251
American Academy of Sleep Medicine (2014) International classification of sleep disorders, 3rd edn. American Academy of Sleep Medicine, Darien
American Foundation for Suicide Prevention (2016) Suicide statistics. AFSP. https://afsp.org/about-suicide/suicide-statistics/. Accessed 26 Dec 2019
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. APA, Arlington
Anderson C, Platten CR (2011) Sleep deprivation lowers inhibition and enhances impulsivity to negative stimuli. Behav Brain Res 217(2):463–466. https://doi.org/10.1016/j.bbr.2010.09.020
Baglioni C, Spiegelhalder K, Lombardo C, Riemann D (2010) Sleep and emotions: a focus on insomnia. Sleep Med Rev 14(4):227–238. https://doi.org/10.1016/j.smrv.2009.10.007
Baldwin CM, Kapur VK, Holberg CJ, Rosen C, Nieto FJ (2004) Associations between gender and measures of daytime somnolence in the sleep heart health study. Sleep 27(2):305–311
Benard V, Etain B, Vaiva G et al (2019) Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: an actigraphy study. J Affect Disord 244:1–8. https://doi.org/10.1016/j.jad.2018.09.054
Benca RM, Obermeyer WH, Thisted RA, Gillin JC (1992) Sleep and psychiatric disorders. A meta-analysis. Arch Gen Psychiatry 49:651–668
Bernert RA, Joiner TE (2007) Sleep disturbances and suicide risk: a review of the literature. Neuropsychiatr Dis Treat 3(6):735–743
Bernert RA, Turvey CL, Conwell Y, Joiner TE (2014) Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: a longitudinal, population-based study of late life. JAMA Psychiat 71(10):1129–1137. https://doi.org/10.1001/jamapsychiatry.2014.1126
Bernert RA, Kim JS, Iwata NG, Perlis ML (2015) Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep 17(3):554
Berrouiguet S, Barrigón ML, Castroman JL, Courtet P, Artés-RodrÃguez A, Baca-GarcÃa E (2019) Combining mobile-health (mHealth) and artificial intelligence (AI) methods to avoid suicide attempts: the Smartcrises study protocol. BMC Psychiatry 19(1):277. https://doi.org/10.1186/s12888-019-2260-y
Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A (2005) Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression. J Clin Endocrinol Metab 90(8):4510–4515
Blasco-Fontecilla H, Alegria AA, Lopez-Castroman J et al (2011) Short self-reported sleep duration and suicidal behavior: a cross-sectional study. J Affect Disord 133(1–2):239–246. https://doi.org/10.1016/j.jad.2011.04.003
Breslau N, Roth T, Rosenthal L, Andreski P (1996) Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biol Psychiatry 39(6):411–418
Brownlow JA, Klingaman EA, Boland EM, Brewster GS, Gehrman PR (2017) Psychiatric disorders moderate the relationship between insomnia and cognitive problems in military soldiers. J Affect Disord 221:25–30. https://doi.org/10.1016/j.jad.2017.06.023
Brundin L, Petersen A, Bjorkqvist M, Traskman-Bendz L (2007) Orexin and psychiatric symptoms in suicide attempters. J Affect Disord 100(1–3):259–263
Chaïb LS, Segovia AP, Baca-Garcia E, Lopez-Castroman J (2020) Ecological studies of sleep disturbances during suicidal crises. Curr Psychiatry Rep 14;22(7):34
Chiu H-Y, Lee H-C, Chen P-Y, Lai Y-F, Tu Y-K (2018) Associations between sleep duration and suicidality in adolescents: a systematic review and dose-response meta-analysis. Sleep Med Rev 42:119–126. https://doi.org/10.1016/j.smrv.2018.07.003
de Klerk S, van Noorden MS, van Giezen AE et al (2011) Prevalence and correlates of lifetime deliberate self-harm and suicidal ideation in naturalistic outpatients: the Leiden routine outcome monitoring study. J Affect Disord 133(1–2):257–264. https://doi.org/10.1016/j.jad.2011.03.021
DeShong HL, Tucker RP (2019) Borderline personality disorder traits and suicide risk: the mediating role of insomnia and nightmares. J Affect Disord 244:85–91. https://doi.org/10.1016/j.jad.2018.10.097
Drapeau C, Nadorff M (2017) Suicidality in sleep disorders: prevalence, impact, and management strategies. NSS 9:213–226. https://doi.org/10.2147/NSS.S125597
Eikelenboom M, Beekman ATF, Penninx BWJH, Smit JH (2019) A 6-year longitudinal study of predictors for suicide attempts in major depressive disorder. Psychol Med 49(6):911–921. https://doi.org/10.1017/S0033291718001423
Enright PL, Newman AB, Wahl PW, Manolio TA, Haponik EF, Boyle PJ (1996) Prevalence and correlates of snoring and observed apneas in 5,201 older adults. Sleep 19(7):531–538
Fawcett J, Scheftner WA, Fogg L, Clark DC, Young MA, Hedeker D (1990) Time-related predictors of suicide in major affective disorder. Am J Psychiatry 147(9):1189–1194
Foley D, Monjan A, Masaki K, Ross W, Havlik R, White L (2001) Daytime sleepiness is associated with 3-year incident dementia and cognitive decline in older Japanese-American men. J Am Geriatr Soc 49(12):1628–1632
Fortier-Brochu E, Beaulieu-Bonneau S, Ivers H, Morin CM (2012) Insomnia and daytime cognitive performance: a meta-analysis. Sleep Med Rev 16(1):83–94
Fujino Y, Mizoue T, Tokui N, Yoshimura T (2005) Prospective cohort study of stress, life satisfaction, self-rated health, insomnia, and suicide death in Japan. Suicide Life Threat Behav 35(2):227–237
Germain A (2013) Sleep disturbances as the hallmark of PTSD: where are we now? Am J Psychiatry 170(4):372–382
Hedegaard H, Curtin SC, Warner M (2018) Suicide rates in the United States continue to increase. NCHS Data Brief 309:1–8
Holdaway AS, Luebbe AM, Becker SP (2018) Rumination in relation to suicide risk, ideation, and attempts: exacerbation by poor sleep quality? J Affect Disord 236:6–13. https://doi.org/10.1016/j.jad.2018.04.087
Hom MA, Chu C, Schneider ME et al (2017) Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: findings from three samples of military service members and veterans. J Affect Disord 209:114–123. https://doi.org/10.1016/j.jad.2016.11.032
Jaussent I, Morin CM, Ivers H, Dauvilliers Y (2017) Incidence, worsening and risk factors of daytime sleepiness in a population-based 5-year longitudinal study. Sci Rep 7(1):1372
Jollant F, Bellivier F, Leboyer M et al (2005) Impaired decision making in suicide attempters. Am J Psychiatry 162(2):304–310. https://doi.org/10.1176/appi.ajp.162.2.304
Kaneita Y, Ohida T, Uchiyama M, Takemura S, Kawahara K, Yokoyama E (2005) Excessive daytime sleepiness among the Japanese general population. J Epidemiol 15(1):1–8
Karacan I, Thornby JI, Anch M, Holzer CE, Warheit GJ, Schwab JJ (1976) Prevalence of sleep disturbance in a primarily urban Florida County. Soc Sci Med 10(5):239–244
Klink M, Quan SF (1987) Prevalence of reported sleep disturbances in a general adult population and their relationship to obstructive airways diseases. Chest 91(4):540–546
Krystal AD, Thakur M, Roth T (2008) Sleep disturbance in psychiatric disorders: effects on function and quality of life in mood disorders, alcoholism, and schizophrenia. Ann Clin Psychiatry 20(1):39–46
Lallukka T, Sares-Jäske L, Kronholm E et al (2012) Sociodemographic and socioeconomic differences in sleep duration and insomnia-related symptoms in Finnish adults. BMC Public Health 12(1):565. https://doi.org/10.1186/1471-2458-12-565
Lamis DA, Innamorati M, Erbuto D et al (2018) Nightmares and suicide risk in psychiatric patients: the roles of hopelessness and male depressive symptoms. Psychiatry Res 264:20–25. https://doi.org/10.1016/j.psychres.2018.03.053
Li SX, Zhang B, Li AM, Wing YK (2010a) Prevalence and correlates of frequent nightmares: a community-based 2-phase study. Sleep 33(6):774–780
Li SX, Lam SP, Yu MW, Zhang J, Wing YK (2010b) Nocturnal sleep disturbances as a predictor of suicide attempts among psychiatric outpatients: a clinical, epidemiologic, prospective study. J Clin Psychiatry 71(11):1440–1446
Lin H-T, Lai C-H, Perng H-J et al (2018) Insomnia as an independent predictor of suicide attempts: a nationwide population-based retrospective cohort study. BMC Psychiatry 18(1):117. https://doi.org/10.1186/s12888-018-1702-2
Littlewood DL, Gooding PA, Panagioti M, Kyle SD (2016) Nightmares and suicide in posttraumatic stress disorder: the mediating role of defeat, entrapment, and hopelessness. J Clin Sleep Med 12(3):393–399. https://doi.org/10.5664/jcsm.5592
Littlewood D, Kyle SD, Pratt D, Peters S, Gooding P (2017) Examining the role of psychological factors in the relationship between sleep problems and suicide. Clin Psychol Rev 54:1–16
Littlewood DL, Kyle SD, Carter L-A, Peters S, Pratt D, Gooding P (2019) Short sleep duration and poor sleep quality predict next-day suicidal ideation: an ecological momentary assessment study. Psychol Med 49(3):403–411. https://doi.org/10.1017/S0033291718001009
Liu JW, Tu YK, Lai YF, Lee HC, Tsai PS, Chen TJ (2019a) Associations between sleep disturbances and suicidal ideation, plans, and attempts in adolescents: a systematic review and meta-analysis. Sleep
Liu B-P, Wang X-T, Liu Z-Z, Wang Z-Y, Liu X, Jia C-X (2019b) Stressful life events, insomnia and suicidality in a large sample of Chinese adolescents. J Affect Disord 249:404–409. https://doi.org/10.1016/j.jad.2019.02.047
Lopes MC, Boronat AC, Wang YP, Fu IL (2016) Sleep complaints as risk factor for suicidal behavior in severely depressed children and adolescents. CNS Neurosci Ther 22(11):915–920
Lopez-Castroman J, Jaussent I, Beziat S et al (2014) Increased severity of suicidal behavior in impulsive aggressive patients exposed to familial adversities. Psychol Med 44(14):3059–3068. https://doi.org/10.1017/S0033291714000646
Lopez-Castroman J, Jaussent I, Gorwood P, Courtet P (2020) Activation syndrome induced by the antidepressant tianeptine and suicidal ideation: evidence from a large depressed outpatient sample. Prog Neuro-Psychopharmacol Biol Psychiatry 97:109762. https://doi.org/10.1016/j.pnpbp.2019.109762
Malik S, Kanwar A, Sim LA et al (2014) The association between sleep disturbances and suicidal behaviors in patients with psychiatric diagnoses: a systematic review and meta-analysis. Syst Rev 3:18. https://doi.org/10.1186/2046-4053-3-18
Matsumoto Y, Uchimura N, Ishida T et al (2016) Day workers suffering from a wider range of sleep problems are more likely to experience suicidality. Sleep Biol Rhythms 14(4):369–376. https://doi.org/10.1007/s41105-016-0067-5
McCall WV, Black CG (2013) The link between suicide and insomnia: theoretical mechanisms. Curr Psychiatry Rep 15(9):389
McCall WV, Blocker JN, D’Agostino R Jr, Kimball J, Boggs N, Lasater B (2010) Insomnia severity is an indicator of suicidal ideation during a depression clinical trial. Sleep Med 11(9):822–827
McCall WV, Batson N, Webster M et al (2013) Nightmares and dysfunctional beliefs about sleep mediate the effect of insomnia symptoms on suicidal ideation. J Clin Sleep Med 9(2):135–140. https://doi.org/10.5664/jcsm.2408
McCall WV, Benca RM, Rosenquist PB et al (2019) Reducing suicidal ideation through insomnia treatment (REST-IT): a randomized clinical trial. Am J Psychiatry 176(11):957–965. https://doi.org/10.1176/appi.ajp.2019.19030267
Mirsu-Paun A, Jaussent I, Komar G, Courtet P, Lopez-Castroman J (2017) Sleep complaints associated with wish to die after a suicide crisis-an exploratory study. J Sleep Res 26(6):726–731
Morin CM, Stone J, Trinkle D, Mercer J, Remsberg S (1993) Dysfunctional beliefs and attitudes about sleep among older adults with and without insomnia complaints. Psychol Aging 8(3):463–467. https://doi.org/10.1037//0882-7974.8.3.463
Nadorff MR, Nazem S, Fiske A (2011) Insomnia symptoms, nightmares, and suicidal ideation in a college student sample. Sleep 34(1):93–98. https://doi.org/10.1093/sleep/34.1.93
Nadorff MR, Fiske A, Sperry JA, Petts R, Gregg JJ (2013) Insomnia symptoms, nightmares, and suicidal ideation in older adults. J Gerontol B Psychol Sci Soc Sci 68(2):145–152. https://doi.org/10.1093/geronb/gbs061
Noh HJ, Joo EY, Kim ST, Yoon SM, Koo DL, Kim D (2012) The relationship between hippocampal volume and cognition in patients with chronic primary insomnia. J Clin Neurol 8(2):130–138
O’Connor RC, Portzky G (2018) The relationship between entrapment and suicidal behavior through the lens of the integrated motivational-volitional model of suicidal behavior. Curr Opin Psychol 22:12–17. https://doi.org/10.1016/j.copsyc.2017.07.021
Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev:97–111
Ohayon MM (2012) Operational definitions and algorithms for excessive sleepiness in the general population: implications for DSM-5 nosology. Arch Gen Psychiatry 69(1):71. https://doi.org/10.1001/archgenpsychiatry.2011.1240
Ohayon MM, Black J, Lai C, Eller M, Guinta D, Bhattacharyya A (2014) Increased mortality in narcolepsy. Sleep 37(3):439–444
Owen-Smith AA, Ahmedani BK, Peterson E et al (2019) The mediating effect of sleep disturbance on the relationship between nonmalignant chronic pain and suicide death. Pain Pract 19(4):382–389. https://doi.org/10.1111/papr.12750
Palagini L, Moretto U, Novi M et al (2018) Lack of resilience is related to stress-related sleep reactivity, Hyperarousal, and emotion Dysregulation in insomnia disorder. J Clin Sleep Med 14(5):759–766. https://doi.org/10.5664/jcsm.7100
Perlis ML, Grandner MA, Chakravorty S, Bernert RA, Brown GK, Thase ME (2016) Suicide and sleep: is it a bad thing to be awake when reason sleeps? Sleep Med Rev 29:101–107. https://doi.org/10.1016/j.smrv.2015.10.003
Pigeon WR, Pinquart M, Conner K (2012) Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry 73(9):1160–1167
Pigeon WR, Funderburk JS, Cross W, Bishop TM, Crean HF (2019) Brief CBT for insomnia delivered in primary care to patients endorsing suicidal ideation: a proof-of-concept randomized clinical trial. Transl Behav Med 9(6):1169–1177. https://doi.org/10.1093/tbm/ibz108
Pompili M, Innamorati M, Forte A et al (2013) Insomnia as a predictor of high-lethality suicide attempts. Int J Clin Pract 67(12):1311–1316. https://doi.org/10.1111/ijcp.12211
Porras-Segovia A, Perez-Rodriguez MM, Lopez-Esteban P, Courtet P, Barrigon MM, Lopez-Castroman J (2019) Contribution of sleep deprivation to suicidal behaviour: a systematic review. Sleep Med Rev 44:37–47
Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD et al (2012) Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord 136(3):743–750
Roberge EM, Bryan CJ, Peterson A, Rudd MD (2019) Variables associated with reductions in insomnia severity among acutely suicidal patients receiving brief cognitive behavioral therapy for suicide prevention. J Affect Disord 252:230–236. https://doi.org/10.1016/j.jad.2019.04.045
Robert G, Zadra A (2008) Measuring nightmare and bad dream frequency: impact of retrospective and prospective instruments. J Sleep Res 17(2):132–139
Robert G, Zadra A (2014) Thematic and content analysis of idiopathic nightmares and bad dreams. Sleep 37(2):409–417
Rössler W, Angst J, Ajdacic-Gross V et al (2018) Sleep disturbances and Suicidality–a longitudinal analysis from a representative community study over 30 years. Front Psych 9:320. https://doi.org/10.3389/fpsyt.2018.00320
Russell K, Rasmussen S, Hunter SC (2018) Insomnia and nightmares as markers of risk for suicidal ideation in Young people: investigating the role of defeat and entrapment. J Clin Sleep Med 14(5):775–784. https://doi.org/10.5664/jcsm.7104
Sandman N, Valli K, Kronholm E, Revonsuo A, Laatikainen T, Paunio T (2015) Nightmares: risk factors among the Finnish general adult population. Sleep 38(4):507–514
Singh B, Hughes AJ, Mehta G, Erwin PJ, Parsaik AK (2016) Efficacy of Prazosin in posttraumatic stress disorder: a systematic review and meta-analysis. Prim Care Companion CNS Disord 18(4). https://doi.org/10.4088/PCC.16r01943
Sjöström N, Waern M, Hetta J (2007) Nightmares and sleep disturbances in relation to suicidality in suicide attempters. Sleep 30(1):91–95. https://doi.org/10.1093/sleep/30.1.91
Sjöström N, Hetta J, Waern M (2009) Persistent nightmares are associated with repeat suicide attempt: a prospective study. Psychiatry Res 170(2–3):208–211. https://doi.org/10.1016/j.psychres.2008.09.006
Soehner AM, Kaplan KA, Harvey AG (2014) Prevalence and clinical correlates of co-occurring insomnia and hypersomnia symptoms in depression. J Affect Disord 167:93–97
Speed KJ, Drapeau CW, Nadorff MR (2018) Differentiating single and multiple suicide attempters: what nightmares can tell us that other predictors cannot. JCSM 14(05):829–834. https://doi.org/10.5664/jcsm.7116
Tishler CL, McKenry PC, Morgan KC (1981) Adolescent suicide attempts: some significant factors. Suicide Life Threat Behav 11(2):86–92. https://doi.org/10.1111/j.1943-278x.1981.tb00907.x
Trockel M, Karlin BE, Taylor CB, Brown GK, Manber R (2015) Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. Sleep:259–265
Turvey CL, Conwell Y, Jones MP, Phillips C, Simonsick E, Pearson JL (2002) Risk factors for late-life suicide: a prospective, community-based study. Am J Geriatr Psychiatry 10(4):398–406
Ursin R (2002) Serotonin and sleep. Sleep Med Rev 6(1):55–69
Vgontzas AN, Bixler EO, Lin HM, Prolo P, Mastorakos G, Vela-Bueno A (2001) Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. J Clin Endocrinol Metab 86(8):3787–3794
Wang X, Cheng S, Xu H (2019) Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression. BMC Psychiatry 19(1):303. https://doi.org/10.1186/s12888-019-2302-5
Ward-Ciesielski EF, Winer ES, Drapeau CW, Nadorff MR (2018) Examining components of emotion regulation in relation to sleep problems and suicide risk. J Affect Disord 241:41–48. https://doi.org/10.1016/j.jad.2018.07.065
Whitney CW, Enright PL, Newman AB, Bonekat W, Foley D, Quan SF (1998) Correlates of daytime sleepiness in 4578 elderly persons: the cardiovascular health study. Sleep 21(1):27–36
Williams SG, Collen JF, Lettieri CJ (2018) More than just a good night’s sleep. J Clin Sleep Med 14(5):709–710. https://doi.org/10.5664/jcsm.7084
Winsler A, Deutsch A, Vorona RD, Payne PA, Szklo-Coxe M (2015) Sleepless in Fairfax: the difference one more hour of sleep can make for teen hopelessness, suicidal ideation, and substance use. J Youth Adolesc 44(2):362–378. https://doi.org/10.1007/s10964-014-0170-3
Winsper C, Tang NKY (2014) Linkages between insomnia and suicidality: prospective associations, high-risk subgroups and possible psychological mechanisms. Int Rev Psychiatry 26(2):189–204. https://doi.org/10.3109/09540261.2014.881330
Wojnar M, Ilgen MA, Wojnar J, McCammon RJ, Valenstein M, Brower KJ (2009) Sleep problems and suicidality in the National Comorbidity Survey Replication. J Psychiatr Res 43(5):526–531. https://doi.org/10.1016/j.jpsychires.2008.07.006
Woznica AA, Carney CE, Kuo JR, Moss TG (2015) The insomnia and suicide link: toward an enhanced understanding of this relationship. Sleep Med Rev 22:37–46. https://doi.org/10.1016/j.smrv.2014.10.004
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lopez-Castroman, J., Jaussent, I. (2020). Sleep Disturbances and Suicidal Behavior. In: Baca-Garcia, E. (eds) Behavioral Neurobiology of Suicide and Self Harm. Current Topics in Behavioral Neurosciences, vol 46. Springer, Cham. https://doi.org/10.1007/7854_2020_166
Download citation
DOI: https://doi.org/10.1007/7854_2020_166
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-57573-1
Online ISBN: 978-3-030-57574-8
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)