Sleep problems have been identified as a risk for suicidal thoughts, plans and attempts

A new study is the first to report that the relationship between nightmares and suicidal behaviors is partially mediated by a multi-step pathway via defeat, entrapment and despair.

The results show that suicidal thoughts, plans or attempts were present in 62% of participants who had nightmares and only 20% of those who did not. Several analyzes suggest that nightmares may act as a stressor in people with post-traumatic stress disorder (PTSD). Nightmares can trigger specific types of negative cognitive thoughts — such as defeat, entrapment, and despair — that reinforce suicidal thoughts and behaviors. The pathways between nightmares and suicidal behaviors appear to operate independently of comorbid insomnia and depression.

“PTSD increases the risk of suicidal thoughts and behaviors, and our study shows that nightmares, a hallmark symptom of PTSD, may be an important treatment target for reducing suicide risk,” said lead researcher Donna L. Littlewood, doctoral researcher in medical and human sciences. science at the University of Manchester. “This study underscores the importance of specifically assessing and targeting nightmares in people with PTSD. Additionally, monitoring and targeting levels of negative cognitive appraisals such as defeat, entrapment, and despair may reduce thoughts and suicidal behaviors.

The results of the study are published in the March 15, 2016 issue of Journal of Clinical Sleep Medicine.

The American Academy of Sleep Medicine reports that nightmares are vivid, realistic, and disturbing dreams usually involving threats to survival or safety, which often evoke emotions of anxiety, fear, or dread. Nightmare disorder can occur when repeated nightmares cause distress or impairment in social or occupational functioning. Nightmares beginning within three months of trauma are present in up to 80% of patients with PTSD, and these post-traumatic nightmares can persist throughout life.

Data for this study was collected from 91 participants who had experienced traumatic events, 51 of whom currently met the criteria for PTSD and 24 others who reported a previous diagnosis of PTSD. Nightmares were measured by summing the frequency and intensity ratings of relevant items on the clinician-administered PTSD scale. Participants also completed questionnaires on suicidal behavior, hopelessness, defeat, and entrapment. Given the interactions between insomnia, PTSD, and suicide, a measure of insomnia was included as a covariate. The analysis was also conducted with and without participants with comorbid depression.

This study was conducted under the supervision of Simon D. Kyle, PhD, of the Sleep and Circadian Neuroscience Institute at the University of Oxford in the UK.

The authors suggest that there are other pathways underlying the relationship between nightmares and suicide that should be identified by further research.

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Material provided by American Academy of Sleep Medicine. Note: Content may be edited for style and length.