Can Sleep Quality Influence Suicide Risk?

Can Sleep Quality Influence Suicide Risk?

Poor sleep is still often viewed as being a symptom of mental health issues. However, research is revealing a much more complex relationship between sleep and mental health in that it can be bidirectional, meaning that poor sleep can also influence mental health outcomes. For instance, research has found that sleep deprivation may trigger bipolar mania (Harvard mental health letter, 2019; Lewis et al., 2017). In addition, poor sleep has been found to trigger depression and anxiety (Al-Abri, 2015; Goldstein et al., 2013), both of which are associated with suicide.

SLEEPLESSNESS AND SUICIDALITY

Recently, research findings have also revealed a relationship between poor sleep and suicidal ideation, suicidal behavior, suicide attempts, and suicide death (Bernert & Joiner, 2007; FAECUM, 2016; McCall & Black, 2013). In particular, insomnia is a risk factor for suicide, and the evidence suggests that this relationship spans across various age groups (McCall & Black, 2013). Suicide risk also increases when nightmares are experienced by younger populations (McCall & Black, 2013).

Because depression and anxiety are linked to insomnia as well as to suicide, one might think that depression and anxiety, rather than sleep, are the factors that influence suicide risk.

However, this argument has not been borne out by the research, which has investigated this relationship and has found that the suicide risk associated with insomnia holds, even when depression is not a factor (McCall & Black, 2013).

While this relationship between suicide and insomnia is seemingly negative, it actually provides for a promising line of research and treatment. Managing insomnia could potentially become a viable method for reducing the risk of suicide. In fact, research continues to grow in this area (McCall & Black, 2013).

Related: SURVIVING SUICIDAL THOUGHTS: MY STORY OF EPIPHANY

SUICIDE RISKS AND SLEEP PATTERNS

Moreover, investigating sleep patterns may provide for a way to identify those who are at greater risk of suicide. In 2016, for instance, a survey of 10 000 students was conducted at the University of Montreal. The survey found that those who had suicidal thoughts also reported experiencing poor sleep quality, thereby leading the authors to conclude in their report that 70.3% of at-risk undergraduates and 56.4% of at-risk graduate students could have been identified simply by filling out a sleep quality survey (FAECUM, 2016).  The report also concluded that it would have been possible to identify 71.8% of undergraduates and 66.5% of graduate students who attempted suicide by examining these same sleep patterns. 

In 2016, I was a member of a joint research team, which was conducting a sleep study investigating the effectiveness of a mobile app in helping people with insomnia to fall asleep more quickly. Coincidentally, this study took place at this same university, the University of Montreal. Because of the various kinds of relationships that exist among insomnia; depression; anxiety; and suicide, our study was explicitly designed to ensure that we could identify participants who were experiencing depression, anxiety, or suicidal ideation. Once identified, these participants were referred to a clinical psychologist who was part of our research team and who could provide them with mental health counseling. 

You may want to read: MONSTER UNDER MY BED AND THE MONSTER IN MY HEAD – MY DIARY OF INSOMNIA

This process, however, was implemented in a research study, not everyday life. 

SLEEP HEALTH AND WELLNESS

Imagine, though, if our universities, places of work, and communities had programs in place to sensitize people to the importance of sleep. Not only could such sleep awareness and education programs be of help to those experiencing sleep troubles, including insomnia, but they could also potentially be used to identify those at greater risk of suicide, even when those at risk do not actively seek counseling for depression, anxiety, or suicidal ideation. 

Although I did not personally experience suicidal ideation, I know all too well the challenges associated with little sleep, having suffered from bouts of insomnia, myself. In fact, my sleep was so chronically poor that I was desperate to find ways to obtain better sleep. This spurred me to explore the sleep research literature. Eventually, my journey into sleep health and wellness led to my actually conducting sleep research, sleep coaching and education, and fatigue risk management. 

Related: WHAT NOT TO SAY TO SOMEONE WITH INSOMNIA

Basically, I help people obtain good sleep. My goal is to ensure that sleep health and wellness become just as important to people as healthy eating and engaging in regular physical activity, principally because many people are currently unaware of the extent to which sleep contributes to their well-being, health, and performance.  

Unlike those with insomnia, who tend to be acutely aware of the impact of a lack of sleep on health and well-being, many people take their sleep for granted, even when they experience the effects of sleep deprivation first-hand. According to the World Health Organization, our world is undergoing a sleep deprivation pandemic, where catching up on sleep over the weekend is a widespread practice and can be heard, somewhat mantra-like, from those who are regularly deprived of sleep. In my experience, some tend to downplay sleep deprivation’s effects or, at least, its negative effects on them personally. However, the impact of sleep deprivation, especially when chronic, is not trivial. Aside from depression, anxiety, burnout, and suicide, other negative effects include traffic accidents, suboptimal learning, hypertension, diabetes, cancer, Alzheimer’s disease, and obesity. 

So, what can you do to obtain better sleep? 

I would say that you can begin by applying the basics of good sleep, which include doing the following:

  1. Maintain a consistent sleep schedule. Doing so will help stabilise your circadian rhythm or body clock. It will be easier for you to fall asleep when you have a regular sleep schedule.
  1. Make sure to get 7 to 9 hours of sleep. Anything less than 7 hours has been associated with poorer sleep quality, health, and well-being.
  1. Practice good sleep hygiene. Sleep hygiene is a set of practices that promotes good sleep. This includes such practices as dimming lights and avoiding blue light in the evening.
  1. Do not eat too close to bedtime. Doing so increases brain activity and can increase the risk of nightmares.
  1. Good sleep starts during the day. How well you manage your emotions during the day, in conjunction with good sleep hygiene, can significantly improve your sleep.
  1. Manage your thoughts at night. You can use a mobile app like mySleepButton to quell your racing mind. It guides you in doing the cognitive shuffle, which primes you for sleep by having you imagine successive random images while in bed.
  1. Relax and know that a good night’s sleep is attainable. When you are unable to obtain a full night’s rest, do not become so preoccupied with sleep that you become anxious. Instead, bear in mind that the consistent application of good sleep health and wellness practices will lead to an eventual improvement in sleep quantity and quality.

Given the links between sleep and mental health, including suicide, increased education on sleep health and wellness is critical. So, please do make sleep a priority and do share what you have learned with others so that they, too, can learn about why sleep is critical to mental and physical health.

For sleep related podcast:  https://anchor.fm/mysleepjourney

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References

Al-Abri, M. A. (2015). Sleep deprivation and depression: A bi-directional association. Sultan Qaboos University Medical Journal, 15(1), e4-e6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318605/

Bernert, R. A., & Joiner, T. E. (2007). Sleep disturbances and suicide risk: A review of the literature. Neuropsychiatric Disease & Treatment, 3(6), 735–743. doi: 10.2147/ndt.s1248

Fédération des assocations étudiantes du campus de l’Université de Montréal. (2016, Oct. 5).  Enquête sur la santé psychologique étudiante. http://www.faecum.qc.ca/ressources/documentation/avis-memoires-recherches-et-positions-1/enquete-sur-la-sante-psychologique-etudiante

Goldstein, A. N., Greer, S. M., Saletin, J. M., Harvey, A. G., Nitschke, J. B., & Walker, M., P. (2013). Tired and apprehensive: Anxiety amplifies the impact of sleep loss on aversive brain anticipation. The Journal of Neuroscience, 33(26), 10607-10615. https://doi.org/10.1523/JNEUROSCI.5578-12.2013

Harvard Mental Health Letter. (Updated 2019, March 18). Sleep and mental health: Sleep deprivation can affect your mental health. https://www.health.harvard.edu/newsletter_article/sleep-and-mental-health

Lewis, K. S., Gordon-Smith, K., Forty, L., Di Florio, A., Craddock, N., Jones, L., & Jones, I. (2017). Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. The British Journal of Psychiatry, 211(3), 169–174. doi: 10.1192/bjp.bp.117.202259

McCall, W. V., & Black, C. G. (2013). The link between suicide and insomnia: Theoretical mechanisms. Current Psychiatry Reports, 15(9): 389-403. doi: 10.1007/s11920-013-0389-9

Sheryl Guloy

Dr. Sheryl Guloy is a researcher, educator, consultant, and sleep coach. Her interest in sleep began with her own sleep troubles and her realization that she is a true night owl. She is co-founder of Somnolence+, a strategic alliance, through which she aims to make sure that more people know about their own sleep and have strategies and tools to help them sleep well.

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