It is well established, as illustrated in the figure above, that abnormalities in the circadian sleep/wake cycle can lead to impairments across a broad spectrum of physiological and mental functions. New research suggests poor sleep may also act as an acute risk factor for suicidal thoughts the next day among young adults already vulnerable to suicide.

In a recent study published in Psychiatry Research, researchers used ecological momentary assessment (EMA) to examine daily fluctuations in specific sleep problems and next-day passive and active suicidal thoughts. The sample included 102 young adults ages 18-35 with a recent history of suicidal thoughts or behaviors.

For 21 days, participants completed daily surveys on their phones rating last night’s sleep quality, nightmares, time awake after sleep onset, and other sleep problems. They also reported on passive and active suicidal thoughts since the prior survey. Passive suicidal ideation included thoughts such as “I wished to be dead”, or “I wished I could go to sleep and not wake up”. Active suicidal thoughts were those such as “I thought about killing myself”.

The study found that on nights when participants experienced more nightmares, lower sleep quality, and more time awake at night than usual, they were more likely to experience increased passive suicidal thoughts the next day. Poor sleep quality and excessive night waking also preceded spikes in active suicidal thoughts.

When examining differences between participants, those who took longer to fall asleep and had more frequent nightmares overall were more prone to passive suicidal thoughts. Longer sleep onset latency was also linked to greater active suicidal thoughts between individuals.

Tests of reverse models found no evidence that daily suicidal thoughts led to subsequent sleep disturbances. This points to a one-directional relationship where sleep disturbances precede spikes in suicidal thinking, rather than the reverse.

These findings have important clinical implications, given that sleep disturbances are treatable. The researchers suggest that assessing for and targeting sleep problems may help mitigate acute suicide risk in patients prone to suicidal thoughts.

Reference:

Cox RC et al. Psychiatry Research. 2023;326:115323. Abstract.