Insomnia May Be at Heart of Suicide

Millions of Americans suffer from sleep disorders. Anyone with friends or family who have experienced insomnia should be aware of a startling new study that may signal impending danger. According to a report out of Mississippi State University and other primarily Southern colleges, people who suffer from insomnia and also drink alcohol may be prone to something far more serious than an epic hangover.

They are at higher risk for suicide.

“A substantial amount of the relation between alcohol use and suicide risk was found to be explained by insomnia symptoms,” said the principal investigator, Dr. Michael Nadorff, director of the sleep, suicide and aging lab at Mississippi State in Starkville, Miss. “In fact, once insomnia symptoms are statistically removed, alcohol use is no longer associated with suicide risk in men, but it remains associated independent of insomnia symptoms for women. “Though our study is preliminary, based upon these findings and the broader literature, patients and clinicians should consider insomnia as an additional warning sign of potential suicidal behavior, not just a symptom of other warning signs, such as depression or alcohol use.” However, alcohol use among men may still be associated with increased suicide risk by being associated with higher levels of insomnia symptoms.

An Important Link

The cross-sectional findings came after examining insomnia symptoms, alcohol use and suicide risk in 375 undergraduate students at Mississippi State. The article was published in the Dec. 2014 Journal of Clinical Sleep Medicine. Other institutions involved in the study were Baylor, Emory and the Veterans Integrated Service Network 19 in Colorado. The U.S. Centers for Disease Control and Prevention lists suicide as the 10th most common reason for death in the United States; in 2013, that total was 41,149. About 88,000 deaths were associated in some way with excessive alcohol use. “We know from previous studies that alcohol use is associated with poor, fragmented sleep, though people often think differently,” Nadorff said. “We wanted to see whether insomnia symptoms may help account for the relation between alcohol use and suicide risk. It does.” Nadorff said he would love to see a longitudinal study in a clinical sample, rather than relying on college students as subjects. Still, suicide was the second-leading cause of death among the 15-to-24 and the 25-to-34 age groups in 2013, accounting for more than 11,000 deaths nationwide.

The Key Domino

Based on this study, insomnia may be the real trigger in alcohol-related suicide, especially in men. Excluding nightmares, which were considered separately, the symptoms of insomnia help explain the relationship between alcohol use and suicide. “We found that a significant amount of the effect between alcohol use and suicide risk was statistically explained by alcohol use being related with higher rates of insomnia symptoms, and those symptoms being associated with higher levels of suicide risk,” researchers wrote. Although insomnia includes disrupted sleep in the course of the night, or failing to get to sleep at all, the Mayo Clinic defines symptoms that include irritability; depression or anxiety; tension headaches; difficulty paying attention or focusing on tasks or remembering; distress in the stomach and intestines; and not feeling well-rested after a night’s sleep. Someone with insomnia may take 30 minutes or more to fall asleep and get six or fewer hours of sleep at least three nights a week for a month or more. Researchers recommended proper assessment and treatment of sleep disorders to reduce the risk of suicide.

Plans for Beating Insomnia

There are a number of options people have to reduce the role insomnia plays in their lives. According to Dr. Michael Thorpy, on behalf of the National Sleep Foundation, “sleep hygiene,” or the practices necessary to have quality sleep, is critical. Among the elements of good sleep hygiene are:

  • Avoid napping during the day.
  • Avoid stimulants (including coffee, tea) and alcohol (which disrupts the second half of sleep) too close to bedtime.
  • Avoid exercise in the evening, although yoga can be done before bedtime.
  • Avoid large meals and experimental dishes close to bedtime.
  • Ensure adequate exposure to natural light during the day; light helps maintain the sleep/wake cycle.
  • Have a regular, relaxing bedtime routine; avoid upsetting conversations, so don’t bring your problems to bed.
  • Associate your bed with sleep; don’t use it to read, watch TV or listen to the radio.
  • Create a pleasant and relaxing environment: Not too hot, cold or bright.

However, all experts aren’t in agreement. In an article “What the Sleep Experts Do to Get a Good Night’s Rest,” weekend work traveler W. Christopher Winter, who counsels athletes on sleep, blocks out 30 minutes at 1 p.m. on Mondays for naps (to compensate for late nights over the weekend). Michael Breus counts backward from 300 by 3s to fall asleep. Michael Grandner, when he can’t sleep after going to bed, goes to a darkened room and writes for at least 30 to 60 minutes. It may take a few weeks of being sleepy during the day, Grandner says, but it can be more effective at treating insomnia than sleeping pills … “but they also need to hang in there,” he said. The latter is good advice for anyone contemplating suicide, who may now have a better understanding of how to beat it. With sleep. “The bottom line is, don’t ignore sleep problems,” Nadorff said. “I don’t think people fully understand the consequences, but it really does have a profound effect on people.” By Martin Henderson

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