Sleep Disturbances and Suicidality in Posttraumatic Stress Disorder: An Overview of the Literature.

Franziska C Weber,Thomas C Wetter,Christine Norra

doi:10.3389/fpsyt.2020.00167

Abstract

A causal relationship between sleep disturbances and suicidal behavior has been previously reported. Insomnia and nightmares are considered as hallmarks of posttraumatic stress disorder (PTSD). In addition, patients with PTSD have an increased risk for suicidality. The present article gives an overview about the existing literature on the relationship between sleep disturbances and suicidality in the context of PTSD. It aims to demonstrate that diagnosing and treating sleep problems as still underestimated target symptoms may provide preventive strategies with respect to suicidality. However, heterogeneous study designs, different samples and diverse outcome parameters hinder a direct comparison of studies and a causal relationship cannot be shown. More research is necessary to clarify this complex relationship and to tackle the value of treatment of sleep disturbances for suicide prevention in PTSD.

Highlights

Suicide is a leading cause of death worldwide with at least 788,000 annual deaths from suicide around the world in 2015 according to WHO data [1]
We conducted a comprehensive search of MEDLINE/PubMed databases using Medical Subject Headings terms in various combinations to identify studies that examined aspects of sleep disorders, suicidality and posttraumatic stress disorder (PTSD)
Another study in veterans found that the association of sleep disturbance with suicidal ideations remained significant after controlling for age, alcohol dependence, depression, and PTSD [49]

Summary

Introduction

Suicide is a leading cause of death worldwide with at least 788,000 annual deaths from suicide around the world in 2015 according to WHO data [1]. Sleep disturbances have been shown to be a risk factor for mental disorders for decades, and are an independent risk factor for suicidal behavior [2]. Sleep problems in general have evolved as an evidence-based risk factor for suicide [3, 4], but short sleep duration seems to be associated with suicidality [5, 6]. Insomnia has been proposed to be an independent risk factor for suicidality [7, 8]. There is evidence for an association between nightmare disorder and suicidality [11,12,13]. The specific contributions of nightmare disorder to suicidality remain unclear [14]. Nightmares are under-reported, detection and treatment are often insufficient [15]

Methods

Results

Discussion

Conclusion