Insomnia is a known risk factor for suicide, but the reason why sleeplessness can drive suicidal behavior in certain individuals is still somewhat of an unknown. Does lack of sleep worsen existing mental health issues, such as depression? Could insomnia itself create an altered mental state that begins to contemplate suicide? Or — for some people — is it something else altogether?

According to a new study from Georgia Regent University published in the Journal of Clinical Sleep Medicine, the journal of the American Academy of Sleep Medicine, the high-risk connection between insomnia and suicide may come from the lack of hope voiced by so many insomnia sufferers that they will ever get another good night’s sleep again.

“It turns out insomnia can lead to a very specific type of hopelessness and hopelessness by itself is a powerful predictor of suicide,” says Dr. W. Vaughn McCall, Chair of the Medical College of Georgia Department of Psychiatry and Health Behavior at Georgia Regents University. “It’s fascinating because what it tells you is we have discovered a new predictor for suicidal thinking.”

To reach their findings, scientists used psychometric testing to objectively assess the mental state of 50 depressed patients age 20-80 being treated as an inpatient, outpatient or in the emergency department at Georgia Regents Medical Center. More than half had attempted suicide and most were taking an anti-depressant. Testing enabled the researchers to filter out other suicide risks such as depression itself and hone in on the relationship between insomnia and suicide risk, asking specific questions about dysfunctional beliefs about sleep such as: Do you think you will ever sleep again?

“It was this dysfunctional thinking, all these negative thoughts about sleep that was the mediating factor that explained why insomnia was linked to suicide,” says McCall, who notes that insomnia patients tend to spiral downward with increasingly negative and unrealistic thoughts about not sleeping, or thinking, for example, that their immune system is being irrevocably damaged.
Overall, the likelihood of being suicidal appears to at least double when insomnia is a symptom.

“If you talk with depressed people, they really feel like they have failed at so many things. It goes something like, ‘My marriage is a mess, I hate my job, I can’t communicate with my kids, I can’t even sleep.’ There is a sense of failure and hopelessness that now runs from top to bottom and this is one more thing,” McCall notes.

If the findings hold true in larger studies, they wave a red flag about suicide risk and point toward the need for prevention that targets the negative thoughts — and underscores how important it is for those experiencing insomnia to finally break the sleeplessness cycle.

Some tips researchers give for helping patients with insomnia include:

• Waking up at the same time every day no matter when you go to bed,
• Not going to bed until you are sleepy,
• Eliminating caffeine, known to stay in your system up to 15 hours,
• Eliminating alcoholic beverages or tobacco products,
• Engaging in cardiovascular exercise at least four hours before bedtime, and
• Allowing ample time to digest a meal before heading to bed.

The one key message McCall hopes sleep sufferers hear? There is hope and help.

“People have choices,” he stresses.