Sunday, December 16, 2012

Link Between Sleep Disturbance and Suicide

Editor's note:  Below is another guest blog post. 
Here is a link to the actual journal article being discussed:
There has been a lot of research looking at the relationship between insomnia and depression.  Insomnia does appear to be a risk factor for depression, but it is difficult in these population-based studies to definitively demonstrate a causal relationship.  The fact that insomnia is one of the symptoms of depression makes it especially difficult.  The article being discussed looks specifically at suicide.
Michael Rack, MD

Lack of good, solid sleep on a regular basis has been recognized by doctors as a risk factor for increased health problems for many years. For example, presence of untreated obstructive sleep apnea (OSA) greatly raises the risk of cardiovascular disease, stroke and premature death. More recent studies have established a link between insomnia and increased risk of suicide. This isn’t completely surprising, given that almost everyone has experienced a sour mood after a poor night of sleep. One can begin to imagine how it would feel for this to go on and on for months or even years.

The question of sleep quality and suicide is a difficult one to approach, and not just because of the emotional nature of the topic. Many studies have found such an association, but they were unclear about cause and effect, especially as depression and/or anxiety were also often involved. It has therefore been uncertain if poor sleep and suicide were, for example, two separate effects of depression or anxiety, versus there being a direct link between lack of sleep and taking one’s life. After all, depression and anxiety are risk factors for both poor sleep and suicidal thoughts and actions.

The newest study does a better job of teasing out the separate variables involved in sleep quality and suicide. The results suggest that even when depression and anxiety are factored into the analysis, people who slept poorly were still more likely to think about, plan, or actually make attempts at suicide. This was possible because tens of thousands of people were considered in the study, and this included many depressed or anxious people who were not bothered by poor sleep. Depressed and anxious people who managed to sleep fairly well were much less likely to commit suicide than similar folks who reported poor sleep.

The study was conducted in Norway, where extremely detailed records are kept of peoples’ health histories as well as all causes of death. Another aspect of the study that gives it significance is that there was a “dose-response” relationship – a term borrowed from tests of medications – between worse sleep and greater likelihood of suicidal thoughts, plans or actions. People who indicated they had poor sleep ‘almost every night’ had significantly more suicidal thoughts and actions than those who said their sleep was poor ‘two or three nights a week’ or ‘once a week of less.’

This most recent study comes on top of many others in the past decade or more that hinted at the same conclusion. While some of those studies were small or had other weaknesses to them, the Norwegian study corrected for virtually all such faults. The study was published in the peer-reviewed medical journal Sleep. It was accompanied by an editorial by Dr. W. Vaughn McCall, a sleep expert at Wake Forest University Health Sciences Center in Winston-Salem, NC. He noted that the cumulative studies on this topic had been done with many different populations of people, both old and young, and concluded bluntly, “The time has come to recognize insomnia as a risk factor for suicide, and to include it in the list of potentially modifiable risk factors.”

This study and the ones preceding it have practical ramifications. Dr. McCall urged doctors to ask more exploratory questions of those patients seeking sleep aids, to determine if there are signs of depression or actual thoughts of suicide that deserve treatment along with the insomnia complaint. As for the average person, those suffering from insomnia should make all reasonable attempts to sleep better, whether by getting more exercise during the day or by visiting their doctors to discuss their sleep problems.

Sometimes getting a better night’s sleep involves only simple behavioral changes, such as not exercising or watching TV right before bedtime. In other cases, a short-term course of medication, perhaps with some counseling sessions, may be in order. The outcome of such interventions may go well beyond simply giving someone a better night’s sleep, to actually having a life-saving effect. is an informational portal helping to educate sleep disorder sufferers and connect them to doctors in their area.