The Surprising Sleep-Suicide Connection

In the first study of its kind, researchers find that feeling hopeless about ever getting a good night’s sleep raises a person’s risk for suicide.

Insomnia has been linked to suicide. But now researchers say a type of hopelessness about ever sleeping well again may be behind the phenomenon. (Photo: Matt Henry Gunther/Getty Images)

Shari Roan is an award-winning health writer based in Southern California.

Let's say you have tens of thousands of dollars in student loans, can't find a good job, and you have the usual everyday stresses on top of that. Less than that can easily cause a person to start wandering the house in the middle of the night, unable to sleep for more than a few hours at a time.

It's a cycle, as any chronic insomniac can tell you, that builds on itself, with long nights and long days bleeding into one another. Now, new research shows that severely disrupted sleep—even if you're not depressed—can make someone so pessimistic and discouraged they may consider suicide.

Getting a good night's sleep makes a difference in our ability to think clearly, have a positive attitude, and shrug off irritations. The new study suggests that chronic insomnia not only makes people prone to accidents, fuzzy thinking, and crabbiness, but it can also make them feel—unrealistically—sure that they'll never get another good night's sleep.

"You get the sense that what they're feeling is hopelessness: discouragement, demoralization about their lack of control over sleep," said Dr. W. Vaughn McCall, chair of the Medical College of Georgia department of psychiatry and health behavior at Georgia Regents University, and the lead author of the new study.

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Previous research shows that insomnia is a risk factor for suicide. But no one has been able to explain how the two are connected. Researchers at the Medical College of Georgia tested 50 people, ages 20 to 80, being treated for depression. More than half had attempted suicide and most were taking an antidepressant. The psychiatric questionnaires were designed to filter out suicide risks related to the depression itself to focus on the relationship between insomnia and suicide risk.

The study, published recently in the Journal of Clinical Sleep Medicine, showed that negative and dysfunctional thinking about sleep was linked to suicidal thoughts. Simply put, these people felt they would never again get a good night's sleep.

The type of insomnia that would trigger this kind of feeling is different from someone who complains about an occasional bad night's sleep. In order for someone's thinking about insomnia to take a distorted turn, the insomnia would need to be chronic, McCall says. There is no definition of what "chronic" is, though.

But, he suggests, "There are people who have an occasional bad night of sleep, have good nights and one bad night, and this can alternate for long periods of time. These folks have some opportunity to snap back. But when more than 50 percent are bad, you start to expect the worse."

Why Do We Commit Suicide?

It's not clear how this despair over poor sleep causes suicidal thinking, but McCall says: "A lot of it revolves around the sense that they can't do anything to help themselves." Experts in sleep medicine say they have a long way to go to get people to realize the importance of sleep to good mental and physical health, he adds: "One of the things the field of sleep medicine spent a long time fighting is making the case that sleep, and good sleep in particular, are not luxuries that can be had or not had. Sleep is essential, and when people have sleep problems it's not trivial."

The new finding may resonate with people, however, because lowering the nation's suicide rate has become a public-health priority. Moreover, suicides among military members have reached epidemic levels. "One of the groups this may be important for is our poor returning veterans, especially the youngest soldiers, who have had a dramatic rise in suicide rates," McCall says.

While the connection between insomnia and suicidal thinking is still perplexing, that shouldn't stop medical professionals from addressing the risk. Some insomnia patients who become suicidal think their immune system is being damaged due to the lack of sleep or the belief there are no treatments that can help them sleep well again. That thinking should be challenged, McCall says. There are numerous effective treatments for insomnia, including medications and behavior and cognitive therapies. "Mental health providers would be well-served to sit up and take notice if a patient reported a sudden deterioration of sleep," he says. "And I would like to think patients would feel validated that, if they went to a doctor with a sleep complaint, they would be taken seriously."

Is it possible to treat chronic insomnia? Why do you think the suicide rate is as high as it is? 

Shari Roan is an award-winning health writer based in Southern California. She is the author of three books on health and science subjects.

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