Study discovers new predictor for suicidal thinking

When people lose hope that they will ever get another good night's sleep, they become at high risk for suicide, researchers report.

Insomnia and nightmares, which are often confused and may go hand-in-hand, are known risk factors for suicide but just how they contribute was unknown, said Dr. W. Vaughn McCall, Chair of the Medical College of Georgia Department of Psychiatry and Health Behavior at Georgia Regents University.

The new study reaffirms that link and adds the element of hopelessness about sleep that is independent of other types of hopelessness, such as those regarding personal relationships and careers, said McCall, corresponding author of the study in Journal of Clinical Sleep Medicine, the journal of the American Academy of Sleep Medicine.

"It turns out insomnia can lead to a very specific type of hopelessness and hopelessness by itself is a powerful predictor of suicide," he said. "It's fascinating because what it tells you is we have discovered a new predictor for suicidal thinking."

If the findings hold true in larger studies, they wave a red flag about suicide risk and point toward prevention that targets the negative thoughts with pharmaceuticals and psychological intervention.

The finding also is a reminder to physicians that depressed patients who report increased sleep problems should be asked if they are having suicidal thoughts, McCall said.

The scientists used psychometric testing to objectively assess the mental state of 50 depressed patients age 20-80 being treated as an inpatient, outpatient or in the Emergency Department. More than half had attempted suicide and most were taking an anti-depressant. Testing enabled the researchers to filter out other suicide risks such as depression itself and hone in on the relationship between insomnia and suicide risk, asking specific questions about dysfunctional beliefs about sleep such as: Do you think you will ever sleep again?

"It was this dysfunctional thinking, all these negative thoughts about sleep that was the mediating factor that explained why insomnia was linked to suicide," said McCall, who specializes in depression and sleep disorders.

He's seen insomnia patients spiral downward with increasingly negative and unrealistic thoughts about not sleeping, thinking, for example, that their immune system is being irrevocably damaged. McCall challenges such negatives from his patients and asks other doctors to consider doing the same: to disagree, strongly stating there is no scientific evidence for the thoughts but there is hope and help. "People have choices," he said.

Once insomnia has been diagnosed, some fairly rigid guidelines can help turn the exhausting and potentially deadly tide, including:

• Wake up at the same time every day no matter when you go to bed
• Not going to bed until you are sleepy
• Eliminating caffeine, known to stay in your system up to 15 hours
• Eliminating alcoholic beverages or tobacco products
• Complete cardiovascular exercise at least four hours before bedtime
• Allowing ample time to digest a meal before heading to bed.

The likelihood of being suicidal at least doubles with insomnia as a symptom, McCall noted.

"If you talk with depressed people, they really feel like they have failed at so many things. It goes something like, 'My marriage is a mess, I hate my job, I can't communicate with my kids, I can't even sleep.' There is a sense of failure and hopelessness that now runs from top to bottom and this is one more thing," McCall said.