By Donna Littlewood.
“What’s no coincidence that the times that I harmed myself, one of the massive reasons of that was that I hadn’t been sleeping. Just total lack of sleep. Majorly. It fucks you up.”
This quote is taken from a man who participated in a research interview on the role of sleep problems in relation to experiences of suicidal thoughts and behaviours. I conducted this study as part of my PhD research which focused on the relationship between sleep disturbance and suicidal thoughts. Previous research had reported a link between sleep problems and suicidal thoughts, attempts and death by suicide. However, not everyone who experiences sleep problems also thinks about suicide. Therefore, my research sought to understand how sleep is related to suicidal thoughts and acts, and specifically identify the other factors which contribute to the relationship between sleep disturbance and suicidal thoughts and behaviours.
To do this, I conducted four pieces of research. For the first study, I identified the previous research which has looked at how sleep problems might be related to suicidal thoughts and behaviours. I then considered the findings from these studies in relation to current theories which try to explain how people develop suicidal thoughts and behaviours. From this work, a series of specific questions were produced which should be addressed through future research.
In the second study, 18 people with experiences of depression and suicidal thoughts and/or attempts participated in interviews about their beliefs regarding the role of sleep in relation to their own experiences of suicide. Themes were identified from the interviews which indicated that: i) being awake in the night was a vulnerable time for suicidal thinking and attempts, primarily due to reduced access to support, ii) inadequate sleep negatively affected people during the day, reducing their ability to cope, control their thoughts, focus their attention and interact with others, and iii) sleep provided an escape from waking-life problems.
For the third study, I examined the relationship between nightmares and suicidal behaviour with 91 people who had symptoms of post-traumatic stress disorder. This showed that nightmares were related to suicidal behaviour, even when levels of depression and insomnia had been taken into account. The second part of this study assessed the extent to which people felt defeated by life (defeat), trapped in their current emotional state (entrapment), and hopeless about the future (hopelessness). Part of the relationship between nightmares and suicidal behaviour was explained by feelings of defeat, entrapment and hopelessness. However, a relationship between nightmares and suicidal behaviour remained, which indicates that other factors contribute to this relationship.
Finally, the fourth study examined whether poor sleep was related to higher levels of suicidal thoughts the following day, and whether suicidal thoughts during the day would predict poor sleep the subsequent evening. In this research, 51 people with depression and suicidal thoughts took part in a 7-day study in which they completed a questionnaire each morning about how they had slept the previous night. They also wore a touch-screen watch for the duration of the study which monitored their sleep patterns, and also asked questions about suicide and other mood related factors at 6 random time-points each day (see image). Specifically, this study showed that short sleep duration and poor sleep quality were associated with higher levels of suicidal thoughts the next day. However, suicidal thoughts did not predict sleep problems the following night.
This study also looked at entrapment, which refers to wanting to escape from your emotional state but feeling trapped and unable to do so. In instances when people experienced high levels of entrapment before going to sleep, sleep quality was found to affect how suicidal they would feel on awakening. Those who felt they’d had a good night’s sleep, had lower levels of suicidal thoughts on awakening. Whilst those who had a poor night’s sleep, awoke with higher levels of suicidal thoughts.
Taken together, findings from this research project highlight the importance of assessing sleep and providing treatment to improve sleep quality and sleep duration when working with people who experience suicidal thoughts. Sources of night-time support should also be established for those who currently experience night-time awakening. Further research is needed, and should particularly focus on understanding the factors which explain the relationship between nightmares, suicidal thoughts and behaviours.
Fellow NetECR member Kirsten Russell is also conducting research investigating sleep, but her work focuses on an adolescent sample. Kirsten recently produced a blog with some great advice for postgrads on the importance of sleep, check it out here.
Donna Littlewood (@donnalittlewood) has a PhD in psychology and is a Research Associate at the NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester (firstname.lastname@example.org).