Sleep Disturbances and Suicidal Behavior

Sleep disturbances encompass a range of problems, including difficulty initiating or maintaining sleep, early morning awakening, non-restorative sleep and distressing dreams. These disturbances are increasingly recognised as modifiable risk factors for suicidal thoughts and behaviours across clinical and non-clinical populations. Insomnia and nightmares in particular exert a pernicious influence on mood regulation, cognitive control and emotion processing, fostering feelings of entrapment, hopelessness and perceived burdensomeness. Biological mechanisms implicate dysregulation of the hypothalamic–pituitary–adrenal axis and alterations in serotonergic signalling, while psychological pathways highlight negative cognitive appraisals, social withdrawal and impaired problem-solving. The association spans diagnoses such as depression, post-traumatic stress disorder and anxiety, as well as community samples, with evidence that even brief sleep loss can precipitate next-day ideation. Effective identification and treatment of sleep disturbances may therefore serve as a vital component of suicide prevention strategies, with potential for both pharmacological and behavioural interventions.

Research from Nature Portfolio

One large-scale synthesis analysed data from longitudinal studies to quantify the extent to which sleep disturbances predict suicidal ideation, attempts and death. The findings indicated that insomnia doubled the likelihood of subsequent suicidal thoughts, while nightmares conferred a similarly elevated risk of suicide attempts. Despite these statistically significant associations, the overall predictive power remained modest, underscoring the need to integrate sleep measures with other clinical indicators for accurate risk assessment. A complementary investigation re-examined the role of nightmares in a national cohort including war veterans and civilian participants. This work confirmed that frequent nightmares independently heighten suicide risk in the general population, even after accounting for traumatic experiences, thereby establishing nightmares as a distinct marker for targeted intervention.

Sleep Disturbances and Suicidal Behavior publication trend

The graph below shows the total number of articles in sleep disturbances and suicidal behavior across all publications each year (not limited to Nature Index journals).

Technical terms

Insomnia: Difficulty initiating or maintaining sleep, or non-restorative sleep, despite adequate opportunity, leading to daytime impairment.

Nightmares: Intense, disturbing dreams that typically result in abrupt awakening and can provoke anxiety or fear.

Suicidal ideation: Thoughts about, consideration of or planning for suicide, ranging from passive wishes to die to active formulation of methods.

Ecological momentary assessment: A research method involving repeated sampling of participants’ experiences and behaviours in real time, often via digital devices.

References

1. Sleep disturbances as risk factors for suicidal thoughts and behaviours: a meta-analysis of longitudinal studies. Scientific Reports (2020).
2. Nightmares as predictors of suicide: an extension study including war veterans. Scientific Reports (2017).
3. Short sleep duration and poor sleep quality predict next-day suicidal ideation: an ecological momentary assessment study. Psychological Medicine (2018).
4. Systematic review and meta-analysis of the relationship between sleep disorders and suicidal behaviour in patients with depression. BMC Psychiatry (2019).
5. Insomnia as an independent predictor of suicide attempts: a nationwide population-based retrospective cohort study. BMC Psychiatry (2018).
6. Examining the role of psychological factors in the relationship between sleep problems and suicide. Clinical Psychology Review (2017).