Link between Nightmares and Suicidal Behavior with PTSD

New research finds that sleep problems — in the form of nightmares — are often associated with suicidal thoughts, plans, or attempts among individuals with post-traumatic stress disorder (PTSD).

Although additional factors influence suicidal thoughts, investigators believe the relationship between nightmares and suicidal behaviors represent feelings of defeat, entrapment, and hopelessness.

In the study, researchers discovered suicidal ideations were present in 62 percent of participants who experienced nightmares and only 20 percent of those without nightmares. Multiple analyses suggest that nightmares may act as a stressor in people with post-traumatic stress disorder (PTSD).

Investigators believe nightmares may trigger specific types of negative cognitive thoughts — such as defeat, entrapment, and hopelessness — which reinforce suicidal thoughts and behaviors. Study findings suggest this pathway between nightmares and suicidal behaviors appears to occur operate independently and not be linked to insomnia and depression.

“PTSD increases the risk of suicidal thoughts and behavior, and our study shows that nightmares, a hallmark symptom of PTSD, may be an important treatment target to reduce suicide risk,” said principal investigator Donna L. Littlewood, Ph.D..

“This study emphasizes the importance of specifically assessing and targeting nightmares within those individuals experiencing PTSD. In addition, monitoring and targeting levels of negative cognitive appraisals such as defeat, entrapment, and hopelessness, may reduce suicidal thoughts and behaviors.”

Study results are published in the Journal of Clinical Sleep Medicine.

The American Academy of Sleep Medicine reports that nightmares are vivid, realistic and disturbing dreams typically involving threats to survival or security, which often evoke emotions of anxiety, fear, or terror.

A nightmare disorder may occur when repeated nightmares cause distress or impairment in social or occupational functioning. Nightmares beginning within three months of a trauma are present in up to 80 percent of patients with PTSD, and these post-traumatic nightmares may persist throughout life.

In the study, researchers followed 91 participants who had experienced traumatic events, 51 of whom met criteria for PTSD currently, and an additional 24 of whom reported a prior 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 questionnaire measures of suicidal behavior, hopelessness, defeat, and entrapment.

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

Investigators believe there are additional pathways underpinning the relationship between nightmares and suicide, and that these be identified through further research.

Source: American Academy of Sleep Medicine/EurekAlert
Man with nightmares photo by shutterstock.