Preventing Suicide Through Early Treatment of Sleep-Related disorders

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A vast amount of research demonstrates that sleep deprivation and sleep disturbances put one at risk for suicide. The various organizations within the U.S. continue to fail at developing effective suicide prevention strategies, and their failure to place emphasis on sleep is one example of this failure. Current methods focus solely on those currently under psychological stress. Our Nation’s strategy must get ahead of suicide by empowering every citizen to implement neurological emergency preparedness before depression, and suicidal behavior develops. Placing more emphasis on identifying and treating sleep-related disorders is a proactive approach toward suicide prevention.

A 2012 study published in the American Journal of Public Health found 45.5% of the 423 veterans who had committed suicide had documented sleep issues[i]. A more recent study published in 2021 in the journal of Sleep found that short sleep duration significantly increases suicide. This study spanned over 19.2 years, analyzing the behavior of 38,786 individuals. The participants in this study who constantly maintained a minimum of 7hrs of sleep did not present suicidal behavior[ii]. A 2011 study published in the journal of Sleep highlights 25 additional studies demonstrating sleep problems are a risk factor for suicidal ideation, suicide attempts, or suicide death[iii].

Why does sleep deprivation increase the risk for suicide? Achieving 7-8 hours of sleep each night is a form of mental health therapy that will empower you to regulate emotions and strengthen the mind to combat suicidal thoughts and behaviors. We pass through four sleep stages of sleep throughout the night, NREM stages 1-3 and REM. We cycle through these stages 4-6 times at night, with each cycle lasting 90-120 minutes. As you sleep, activity in the brain begins to slow, with stage 3 NREM being the slowest. As you transition into REM, the brain activity picks back up.

Brain activity varies throughout the four stages, with critical repair and restoration occurring inside the brain within each stage. Failure to achieve 7-8 hours of sleep or experiencing sleep disturbances prevents a natural mental health therapy from occurring, resulting in cognitive dysfunction and reduced emotional regulation. It then becomes more challenging to combat the brain’s automatic negative responses toward the world, influencing suicidal thoughts.  

Additionally, lack of sleep prevents the storage of positive memories and influences the long-term storage of negative memories. Sleep disturbances and or sleep deprivation can cause the brain to store traumatic experiences that will impact your mental health while you are awake [iv]. Sleep deprivation prevents the brain during REM from adequately encoding long-term memories that enable positive emotional regulation.

Each night during REM, the brain replays the day’s events and begins a long-term memory storage process. With a disruption of sleep, stress hormones release, which causes more negative emotional experiences to be stored, resulting in increased stress, anxiety, and depression during the awakening period [v].

For example, let’s say during the day you were in a car crash. Suppose you sleep for a good 7-8 hours that night. In that case, your brain will perform its natural mental health therapy and store the positive memories that will prevent this trauma from impacting you emotionally in the future. However, suppose your sleep is disrupted, and stress hormones are released. In that case, there will be more negative emotions stored in your brain, resulting in constantly reliving the past traumatic experiences.

Therefore, sleep disturbances put you at a higher risk for suicide. Those already suffering from neurological disorders are more likely to experience sleep-related conditions and are at an even higher risk for suicide. Research demonstrates that even those with no history of anxiety or depression are at risk for suicide when sleep-deprived. We can proactively use this information to develop a suicide prevention strategy that focuses on those who do not currently demonstrate suicidality. This is a “get out of jail free card.” Preventive measures implemented now can prevent suicide in the future.  

A Sleep Medicine Approach to Suicide Prevention

The first step is to empower those already diagnosed with sleep-related disorders such as insomnia or Obstructive Sleep Apnea (OSA) with emotional regulatory skills. When treating patients with OSA, most sleep clinics focus primarily on CPAP adherence and place little emphasis on empowering the patients to deal with insomnia or the effects of emotional regulation. Most of those diagnosed with OSA develop insomnia as well. For this reason, I recommend that those diagnosed with sleep disorders also receive mental health therapy from a mental health professional competent in sleep-related conditions.

The stigma toward mental health can discourage those with sleep problems from seeking mental health therapy. Labeling this therapy as sleep hygiene training rather than mental health therapy is crucial in encouraging the patient to seek care. Insomnia is a disorder found in the Statistical Manual of Mental Disorders (5th edition), the primary diagnostic manual for mental disorders. Most behavioral health therapists are competent in treating this condition. [vi] When a therapist empowers a client to deal with insomnia, they will also develop the skills to regulate emotions, improving their sleep quality.

Identifying and treating those who remain undiagnosed for sleep-related is another suicide prevention strategy. Thirty percent of the adult U.S. population suffers from insomnia, and 10 million people in the U.S. stay undiagnosed for obstructive sleep apnea. Thirty-seven percent of the U.S. population report getting less than 7-hours of sleep[vii]. Screening to identify those who may have a sleep-related, then treating the disorder combined with sleep-related mental health therapy can help prevent sleep-related suicidal behavior.

Below are three sleep screening tools frequently used in sleep medicine to help identify the millions of Americans susceptible to suicide because of an undiagnosed sleep-related disorder.

• STOP-BANG OSA screening tool. STOP-BANG is an acronym for Snoring, Tired, Observed breathing issues, blood Pressure- Body mass index, Age, Neck size, and Gender. The STOP-BANG provides a score between 0-8. If your score is 0-2, you are a low risk for OSA, 3-4 is an intermediate risk, 5-8 is high risk.

• Epworth Sleepiness Scale (ESS). The ESS is used to assess your level of daytime sleepiness. Scoring a six or higher on the ESS demonstrates a high chance of having a sleep disorder.

• The Insomnia Severity Index (ISI) The ISI serves as an insomnia tool to self-screen one’s perception of their level of insomnia. The ISI uses seven questions assessing your sleep onset difficulties and your satisfaction with your current sleep. Scoring a 15 or higher on this questionnaire indicates that you have insomnia.

It’s frustrating to watch our Nation fail to develop a preventive approach toward suicide. The current efforts focus purely on those suffering, which is good and must continue. However, at the same time, we must also focus on strengthening in advance the brains of those who are not currently experiencing depression. We must empower everyone to develop cognitive emergency preparedness.

We must prepare in advance to resiliently overcome the unexpected stressors of life that comes crashing in when we least expect it. Emphasizing sleep well before developing depression can prevent one from finding themselves on the path to suicide. Research demonstrates that focusing on sleep is a proactive suicide prevention approach that will help reduce the number of our Nation’s suicides.

[i] Pigeon, Wilfred R., Peter C. Britton, Mark A. Ilgen, Ben Chapman, and Kenneth R. Conner. “Sleep Disturbance Preceding Suicide Among Veterans.” American Journal of Public Health 102, no. S1 (2012): S93-7. https://dx.doi.org/10.2105%2FAJPH.2011.300470

[ii] Karin, Anna Hedstöm, Ola Hössjer, Rino Bellocco, Weimin Ye, Lagerros Ylva Trolle, and Torbjörn Åkerstedt. “Insomnia in the Context of Short Sleep Increases Suicide Risk.” Sleep 44, no. 4 (2021): 1-7. https://doi.org/10.1093/sleep/zsaa245

[iii] McCall, W.V. “Insominia is a Risk Factor For Suicide: What Are the Next Steps?” Sleep 34, no. 9 (2011): 1149-50. https://doi.org/10.5665/sleep.1222

[iv] Walker, P. Matthew, and Els van der Helm. “Overnight Therapy? The Role of Sleep in Emotional Brain Processing.” American Psychological Association Bulletin 135, no. 5 (2009): 731-48. https://doi.org/10.1037/a0016570

[v] ibid

[vi] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC: American Psychiatric Association Publishing, 2013.

[vii] Sleep Advisor. 54 Shocking Sleep Statistics and Trends for 2021. Accessed February 12, 2022. www.sleepadvisor.org/sleep-statistics.

About Post Author

Chris Pierce

chris.pierce23@gmail.com

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