On this episode, Georgia Punton tells us about her PhD work on how sleep affects how we are able to control our thoughts. Her work links sleep deprivation and hallucinations and posits that hallucinations may be more likely for everyone when we are sleep deprived.
Show notes:
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Dementia with Lewy bodies (DLB) is the second most common type of dementia. DLB is a complex and heterogenous disorder, which is characterised by a range of symptoms, including neuropsychiatric symptoms, visuoperceptual difficulties and visual hallucinations.
The challenging, complex and symptom profile of people with DLB can have a significant impact upon their caregivers. DLB places a significant level of burden upon caregivers, and DLB caregivers typically report greater levels of distress than the caregivers of people with Alzheimer’s dementia (AD), or other types of dementia, even when DLB patients have a similar level of cognitive impairment. This has been shown to relate to the presence and severity of patient symptoms.
Caregiver distress is extremely likely to result in DLB caregivers developing sleep disturbances and disorders. A wide range of studies have indicated that stress is associated with subjective and objective sleep disturbances, and that stressful events can predict future sleep disturbances. Indeed, work from dementia caregivers, considered as a whole, demonstrates this: relative to age-matched control non-caregiver adults, caregivers have significant reductions in sleep duration (equivalent to losing up to 3.5 hours of sleep per week) and sleep quality. Additionally, even professional dementia caregivers demonstrate increased levels of stress hormones.
To date, no studies have specifically assessed sleep in DLB caregivers, or the relationship with stress and patient neuropsychiatric symptoms. This is extremely important as given the complex and challenging symptom profile of DLB, DLB caregivers are likely to be at a high risk of developing sleep disturbances and disorders. This is likely to have a direct negative impact upon their health.
Taken together, it is important to understand the nature of sleep disturbances in DLB caregivers. In particular, it is necessary to identify patient events or stressors which may negatively impact upon specific aspects of caregiver subjective and objective sleep. This will allow for the development and testing of bespoke DLB caregiver sleep interventions. This is important as techniques which optimise sleep in this population will benefit individual caregivers, as well as potentially having wider economic and societal benefits.
What is the goal of the proposed PhD Project?
The goals of this PhD project are to:
to examine, quantify, and compare the nature of subjective and objective sleep disturbances in DLB and AD caregivers
to examine the association between specific patient neuropsychiatric symptoms and DLB caregivers
design a bespoke DLB-specific caregiver intervention to improve sleep, and pilot and test its feasibility and effectiveness
This proposed studentship is very closely aligned with Dr. Elder’s current research programme, which is primarily focussed on subjective and objective sleep in patients with dementia with Lewy bodies.
What skills and knowledge does the PhD candidate need?
We are looking for an applicant who is passionate about clinically-applied sleep research. Given the novel nature of the project, you should demonstrate a high degree of professionalism and independence. You should possess a solid understanding of quantitative research methods and be willing to be trained in a variety of advanced sleep research methodologies (e.g. actigraphy, polysomnography).
Applicants will normally have a track record of academic achievement in psychology or a related discipline, demonstrated by a first class or upper second undergraduate honours degree and/or a master’s degree (or equivalent)
About the supervisors
Dr. Greg Elder is Associate Director of Northumbria Sleep Research and is a Senior Lecturer in the Department of Psychology. He is an experienced sleep researcher with expertise in the design, conduct and management of sleep research studies, including overnight polysomnography. Dr. Elder also has a wide range of expertise in designing and managing research studies involving patients with dementia with Lewy bodies, including interventional studies and clinical trials; additionally, he has expertise in the role of stress in sleep disturbances and insomnia, and behavioural interventions in this context. Dr. Elder is a Chartered Psychologist.
Dr. Daniel Rippon is a Senior Lecturer in the Department of Psychology. He has expertise in the design and conduct of research studies involving dementia caregivers. Dr. Rippon also has relevant clinical and research links with the Campus of Ageing and Vitality (Newcastle University), where he has developed a home-based service for supporting caregivers, and has clinical experience working within the NHS.
Professor Jason Ellis is Director of Northumbria Sleep Research and is a Professor of Sleep Science in the Department of Psychology. Professor Ellis has a wide range of expertise in the development and testing of behavioural interventions for insomnia.
More information and how to apply
If you would like to discuss the opportunity, please contact the principal supervisor by email (Dr. Greg Elder: g.elder@northumbria.ac.uk).
Details on how to submit an application are below. We’ve added some useful reading for prospective candidates at the end of the post
The advert for the post can be found here, this includes full eligibility requirements. As part of the application process you will need to submit a 1000 word proposal of how you would approach the project by 18th February 2022
Full details of the application process can be found here
A good night’s sleep is important for many reasons. It helps our body repair itself and function as it should, and is linked to better mental health and lower risk of many health conditions – including heart disease and diabetes. It’s also been shown that not getting enough sleep is linked to cognitive decline and conditions such as Alzheimer’s disease.
But more isn’t always better, as one recent study found. Researchers from the Washington University School of Medicine have published a paper that indicates that just like getting too little sleep, sleeping too much may also be linked with cognitive decline.
The research team wanted to know how much sleep was linked to cognitive impairment over time. To do this, they looked at 100 older adults in their mid-to-late-70s on average, and tracked them for between four and five years. At the time of their study, 88 people did not show any signs of dementia, while 12 showed signs of cognitive impairment (one with mild dementia and 11 with the pre-dementia stage of mild cognitive impairment).
Throughout the study, participants were asked to complete a range of commonplace cognitive and neuropsychological tests to look for signs of cognitive decline or dementia. Their scores from these tests were then combined into a single score, called the Preclinical Alzheimer Cognitive Composite (PACC) score. The higher the score, the better their cognition was over time.
Sleep was measured using a single-electrode encephalography (EEG) device, which participants wore on their forehead while sleeping, for a total of between four to six nights. This was done once, three years after people first completed their annual cognitive tests. This EEG allowed the researchers to accurately measure brain activity, which would tell them whether or not someone was asleep (and for how long), and how restful that sleep was.
Participants would have worn a device similar to this to track their sleep. wideonet/ Shutterstock
Although sleep was only measured at one period during the study, this still gave the research team a good indication of participants’ normal sleep habits. While using an EEG to measure brain activity may be somewhat disruptive to sleep on the first night, as people get used to the equipment, sleep tends to return to normal the following night. This means that when sleep is tracked from the second night onwards it’s a good representation of a person’s normal sleep habits.
The researchers also took into account other factors that can affect cognitive decline – including age, genetics and whether a person had signs of the proteins beta-amyloid or tau, which are both linked to dementia.
Overall, the researchers found that sleeping less than 4.5 hours and more than 6.5 hours a night – alongside poor quality sleep – was associated with cognitive decline over time. Interestingly, the impact of sleep duration on cognitive function was similar to the effect of age, which is the greatest risk factor for developing cognitive decline.
A good night’s sleep
We know from previous research that lack of sleep is linked to cognitive decline. For example, one study showed that people who reported sleep disturbances, such as insomnia or excessive daytime sleepiness, have a greater risk of developing dementia compared to people who don’t. Other research has shown that people who have short sleeping times have higher levels of beta-amyloid in their brain – which is commonly found in the brains of people who have Alzheimer’s disease.
Researchers don’t know for certain why lack of sleep is linked to cognitive decline. One theory is that sleep helps our brain flush out harmful proteins that build up during the day. Some of these proteins – like beta-amyloid and tau – are thought to cause dementia. So interfering with sleep might interfere with our brain’s ability to get rid of these. Experimental evidence even supports this – showing that even just one night of sleep deprivation temporarily increases beta-amyloid levels in the brain of healthy people.
But it’s less clear why long sleep is linked with cognitive decline. Previous studies have also found a link between over-sleep and cognitive performance, but most relied upon participants self-reporting how long they sleep nightly – which means the data is less accurate than using an EEG to measure brain activity. This new study therefore adds weight to such findings.
What’s surprising about this study’s findings is that the optimal sleep duration is much shorter than that which previous studies have suggested are problematic. The study showed that sleeping longer than 6.5 hours was associated with cognitive decline over time – this is low when we consider that older adults are recommended to get between seven and eight hours of sleep every night.
It could be the case that it isn’t necessarily the length of the sleep that matters, but the quality of that sleep when it comes to risk of developing dementia. For instance, this study also showed that having less “slow-wave” sleep – restorative sleep – particularly affected cognitive impairment.
What we also cannot tell from this study is if long sleep durations can independently predict cognitive decline. Essentially, we can’t rule out that participants who slept longer than 6.5 hours every night might not have already had pre-existing cognitive problems of brain changes suggestive of dementia that weren’t picked up on the tests. And although the researchers were careful to adjust for dementia-related factors, longer sleepers may also have had other pre-existing conditions that might have contributed to their cognitive decline which weren’t taken into account. For example, this could include poor health, socioeconomic status or physical activity levels. All of these factors together may explain why longer sleep was linked to cognitive decline.
There are many factors which can impact on both our sleep quality, and whether we experience cognitive decline. While some factors aren’t preventable (such as genetic predisposition), there are many things we can do alongside getting a good night’s sleep to help reduce our likelihood of developing dementia – such as exercising and eating a healthy diet. But while the researchers of this study seem to suggest there’s an optimal sleep duration – between 4.5 and 6.5 hours every night – the occasional weekend lie-in is unlikely to do your brain any harm.
The 18th October is World Menopause Day. Researchers in the psychology department are working to futher our understanding of menopause, how it impacts women and how we can alleviate some of the negative symptoms of menopause. In this post, Professor Crystal Haskell-Ramsay explains the basics of menopause and tell us about her teams current research projects, from research in to sleep disturbances, dietary changes and menopause in the workplace.
Menopause is a normal, natural life event experienced by most women, and some men. Menopause results in lower levels of oestrogen and other hormones and is defined as the permanent loss of menstrual periods, usually confirmed when a period is missed for 12 consecutive months. This typically occurs between ages 40 and 58, with the average age being 51.
Perimenopause is the stage from the beginning of menopausal symptoms to the postmenopause and can last anywhere from a few months to several years. During the perimenopause, hormone levels change and the ovaries start to produce fewer eggs. Although over half of the world will experience menopause and the potential for debilitating symptoms associated with it, this important life event receives very little attention and is often not discussed.
Hot, sweaty and sweary
There are a number of common physical symptoms associated with perimenopause and menopause, including:
Changes to your menstrual cycle
Hot flushes
Night sweats
Headaches
Dizziness
Vaginal dryness
Incontinence and bladder problems
Weight gain
Joint and muscle pain
Difficulty sleeping
Common psychological symptoms include:
Feeling depressed
Anxiety
Mood swings
Problems with memory and concentration – “brain fog”
Loss of interest in sex
However, experience of the menopause is different for everyone and a lack of awareness of the full array of symptoms both from the point of view of the individual and often within the medical profession can lead to menopause not being diagnosed. Psychological symptoms are particularly likely to be missed and often anti-depressants are prescribed without identification of menopause as the underlying cause.
Managing menopause symptoms through diet
Alternatives to anti-depressants include dietary supplements and herbal extracts and there are a range of these supplements that are marketed with claims to improve symptoms related to menopause. Unfortunately, research examining the effects of these supplements is limited and there is a lack of good evidence to support the claims made. However, research has indicated that a high intake of oily fish and fresh legumes is associated with delayed onset of natural menopause whereas refined pasta and rice was associated with earlier menopause. A higher intake of vitamin B6 and zinc was also associated with later age at menopause.
A limited number of studies have also assessed the role of diet in reducing or exacerbating menopausal symptoms. A recent systematic review indicated that lower intensity of symptoms was associated with a diet comprising of more vegetables, whole grain and unprocessed food. However, the majority of studies in this area have focused on specific aspects of menopause symptoms or on specific aspects of the diet, with a lack of studies conducted in the UK.
Overall, evidence on the relationship between dietary intake and menopausal symptoms is inconsistent and inconclusive. Within the Psychology department at Northumbria we are currently conducting research exploring the relationship between menopause symptoms, mental wellbeing, and diet in a UK population.
Menopausal sleep disturbance
Sleep disturbances are extremely common during menopause, where specific problems include difficulties with falling asleep, frequent awakenings, awakening too early, insomnia, and excessive daytime sleepiness. Therefore, interventions which improve or prevent menopause-related sleep disturbances are extremely important and are likely to aid physical and psychological health. To date, there are no systematic reviews of nutritional interventions to treat menopause-related sleep disturbances. Researchers within the department are currently completing a systematic review of the literature exploring nutritional interventions for menopause-related sleep disturbances.
The findings from both of the current projects relating to diet will inform the development of subsequent nutritional intervention trials examining the impact on menopausal symptoms and specifically on sleep disturbances in menopause.
Menopause in the workplace
As menopause is rarely discussed this can lead to a lack of support and issues in the workplace. Almost one million women in the UK have left jobs as a result of menopausal symptoms. As the issue mainly affects those in their late 40s and early 50s, this leads to women eligible for senior management roles leaving work at the peak of their career. This also leads to knock-on effects to workplace productivity, the gender pay gap and the gender pension gap.
In July it was announced that an inquiry was being launched by the Commons cross-party women and equalities committee examining “An invisible cohort: why are workplaces failing women going through the menopause?”. This inquiry will scrutinise existing legislation and workplace practices and will draw up recommendations with a view to shaping policies to address gender equality. As stated by the Chair of this committee:
“Three in every five women are negatively affected at work as a result of the menopause. The repercussions of that are not merely individual. Excluding menopausal women from the workplace is detrimental to our economy, our society and our place on the world stage.”
Chair of the Women and Equalities Committee, Rt Hon Caroline Nokes MP
Whilst this issue is gaining some attention there is still a lack of awareness of individual’s experiences of menopause in the workplace and particularly the types of support that may lead to improvements in psychological symptoms of the perimenopause/menopause.
The projects described above are all being conducted in collaboration with paid student interns or placement students (Abi Glancey, Maddy Lane, Dominik Polasek) as well as staff members in Psychology: Greg Elder, Vicki Elsey, Nayantara Santhi and Michael Smith.
Dreams are patterns of sensory information that occur when the brain is in a resting state – as in asleep. It is generally assumed that dreams only occur during rapid eye movement (REM) sleep – this is when the brain appears to be in an active state but the individual is asleep and in a state of paralysis. But studies have shown that they can also happen outside of REM.
Research from sleep studies, for example, shows that REM-related dreams tend to be more fantastical, more colourful and vivid whereas non-REM dreams are more concrete and usually characterised in black and white. Recent studieson dreaming show that during a dream (and in particular a REM-related dream) the emotional centre of the brain is highly active whereas the logical rational centre of the brain is slowed. This can help explain why these dreams are more emotive and surreal.
Evolutionary theory suggests the purpose of dreams is to learn, in a safe way, how to deal with challenging or threatening situations. Whereas the “memory consolidation” theory suggests that dreams are a byproduct of reorganising memory in response to what has been learned throughout the day.
Both theories have at least one thing in common – during times of stress and anxiety we either dream more or remember our dreams more often, as a way of coping with challenging circumstances and new information. This is also in line with another theory of dreaming – the mood regulatory function of dreams theory, where the function of dreams is to problem-solve emotional issues.
Anxiety and stress dreams
While there is no evidence that we dream more when we are stressed, research shows we are more likely to remember our dreams because our sleep is poorer and we tend to wake in the night more frequently.
Studies show the dreams of people with insomnia (a disorder largely characterised by stress) contain more negative emotion and are more focused on the self, in a negative light. Also, the dreams of people with insomnia tend to focus on current life stressors, anxieties and can leave an individual with a low mood the following day.
Outside of insomnia, research has found that people who are depressed, while going through a divorce, appear to dream differently compared to those who are not depressed. They rate their dreams as more unpleasant. Interestingly though the study found that those depressed volunteers who dreamt of their ex-spouse were more likely to have recovered from their depression a year later compared to those that did not dream of the ex-spouse. Participants whose dreams changed over time, to become less angry and more pragmatic, also showed the greatest improvements. The question is why?
Although our senses are dampened during sleep (with vision being completely absent), strong sensory information, such as an alarm, will be registered and in some cases incorporated into the dream itself. We also know that during times of stress we are more vigilant to threat (on cognitive, emotional and behavioural levels), so it stands to reason that we are more likely to incorporate internal and external signals into our dreams, as a way to manage them. And this may account for these changes in our dreams, when we are anxious, depressed or sleeping badly.
How to sleep better
The current thinking is stress reduction before bed and good sleep management – such as keeping a consistent sleep routine, using the bedroom only for sleep, making sure the bedroom is cool, dark, quiet and free from anything arousing – will reduce awakenings at night and so the frequency of stress-related negative dreams.
That said, using a technique called Imagery Rehearsal Therapy (IRT), mainly used for treating nightmares in people with post-traumatic stress disorder, it appears stress and anxiety associated with nightmares and bad dreams as well as the frequency of bad dreams can be reduced. This is achieved by re-imagining the ending of the dream or the context of the dream, making it less threatening.
There is also evidence that IRT is effective for reducing nightmares in children. Although IRT is thought to be successful by giving the dreamer a sense of control over the dream, this hasn’t been well studied in people who are stressed or anxious.
That said, a recent study showed that teaching people with insomnia to be aware while they were dreaming and to control the dream, as it occurs – known as lucid dreaming training – not only reduced their insomnia symptoms but also reduced their symptoms of anxiety and depression. Perhaps then the key is to manage the dreams as opposed to trying to manage the stress – especially in uncertain times.
It should be one of the most relaxing times of the day. You climb into bed, get comfortable and cosy, start to feel your brain slowing down … and then suddenly you experience a shocking falling sensation. It’s like you misjudged the number of stairs you were walking down, leaving your leg in mid air for just a bit longer than you expected. Not pleasant.
This bedtime tumbling sensation is the phenomenon known as the “hypnic jerk” and may sometimes be accompanied by a visual hallucination. You may have heard it called a “sleep start”, the “hypnagogic jerk” or the “myoclonic jerk”, but for the sake of sanity we’ll just stick with the former.
So what is it?
The hypnic jerk occurs when the muscles, usually in the legs (although they can be observed throughout the body), involuntarily contract quickly, almost like a twitch or spasm. Although the reasons behind this are not that well understood, the evolutionary perspective suggests that it serves at least two important but interrelated functions, the former of which is still relevant today.
First, this sudden awakening allows us to check our environment one last time, an opportunity to ensure that it really is safe to go to sleep by creating a startle-like response. You might have accidentally dropped off somewhere dangerous, after all.
Another suggested evolutionary function is that it allowed us – or at least our early ancestors – to check the stability of our body position before we went to sleep, especially if we started to fall asleep in a tree. The jerk would allow us to test our “footing” before unconsciousness set in. https://www.youtube.com/embed/Mg_66TRsb6Y?wmode=transparent&start=0
The other main theory suggests that the hypnic jerk is merely a symptom of our active physiological system finally giving in, albeit sometimes reluctantly, to our sleep drive, moving from active and volitional motor control to a state of relaxation and eventual bodily paralysis. In essence, the hypnic jerk may be a sign of the eventual switch over between the brain’s recticular activating system (which uses arousal neurotransmitters to aid wakefulness) and the ventrolateral preoptic nucleus (which utilises inhibitory neurotransmitters to reduce wakefulness and promote sleep).
When jerks go bad
Either way, although in most cases a normal and natural phenomenon, the hypnic jerk can be a rather disconcerting or frightening experience. In extreme cases – whether in terms of frequency or the velocity and violence of the jerk – it can keep people awake, preventing them from entering the normal sleep onset process, resulting, in the longer-term, in a form of sleep-onset insomnia.
As the hypnic jerk is related to motor activity, anything that is going to keep your motor system active at night is likely to increase the chances of you having one – and possibly even a more intense one, too.
As such, caffeine (or other stimulants) and/or vigorous exercise in the evening and high stress and anxiety levels at night are associated with an increased chance of a spontaneous hypnic jerk and should, where possible, be avoided. Other associations include being overtired or fatigued, sleep deprived or having an erratic sleep schedule. Here, keeping a good regular sleep/wake pattern can help. https://www.youtube.com/embed/39a_XWaJ7As?wmode=transparent&start=0
Finally, from a nutritional perspective, it has been suggested, albeit anecdotally, that deficiencies in magnesium, calcium and/or iron can also increase the chances of experiencing a spontaneous hypnic jerk. That said, it has also been suggested that hypnic jerks can be evoked through sensory stimulation, during the sleep onset period, so ensuring that your sleep environment is cool, dark and quiet may be helpful in reducing the frequency and intensity of them.
There is actually very little research on the topic, presumably because it is largely seen as a normal phenomenon, making it difficult to suggest a definitive “treatment”. However, we do know that as we get older the number of hypnic jerks we will experience should decrease naturally. The main issue to consider here is whether the hypnic jerk is causing you or your bed partner a problem? If it is, then it is time to see a sleep specialist. The difficulty is there are a number of sleep disorders, such as sleep apnoea, that have symptoms which mimic the experience.
And if all else fails, perhaps just blame the ancestors.
Over the last 12 years at Northumbria Sleep Research we have been studying the pathophysiology of insomnia. In other words, how can two people have the same experiences in life and yet one develops insomnia and the other does not?
As there was no working definition of acute insomnia (the period prior to it being classed as a sleep disorder), prior to us starting this work, the first thing we had to do was create a clinical definition of acute insomnia. We did this in terms of having existing vulnerabilities, how it can start, how long someone should have it to be classified, what symptoms they should experience and how frequently they should experience those symptoms every week.
Using this definition, we then demonstrated how many people in the general population are affected by it at any given time (prevalence = 7.9%) and how many people will be affected by it over the course of a year (annual incidence = 31-36%) in the UK and USA. We then went on to examine what makes people with acute insomnia different from normal sleepers and people with chronic insomnia along several dimensions (genetic, physiological, neuropsychological, psychological, social, behavioural and environmental).
These findings include, changes in the timing of the human body clock, differences in brain-wave activity during sleep, how preoccupied we are with our sleep during the day, our levels of depression and how much time we spend in bed awake worrying.
Why is preventing chronic insomnia important in the context of COVID?
We have seen a sharp increase in people reporting acute insomnia over the crisis. This increase has been attributed not only to fears and concerns about the virus itself but worry and anxiety about family and friends. There have also been increases in financial and work-related pressures and lifestyle and routine changes due to the lockdown which can also negatively impact on sleep.
If left untreated, acute insomnia can develop into a chronic insomnia which increases the risk, significantly, for several physical and psychological illnesses (for example Northumbria Sleep Research were the first to demonstrate that untreated acute insomnia significantly increases the risk for a first episode of depression).
Within the context of COVID specifically, there is lots of evidence that good sleep can; i) minimise the chances of contracting a virus, if exposed, ii) increase the recovery rate after contracting a virus and iii) increase the speed at which immunity occurs following vaccination. Together, this underscores the reasons why identifying and preventing chronic insomnia is so important at the moment.
How are staff in the Northumbria Centre for Sleep Research helping?
One of the most important things about doing research, at least in our view, is that it must have implications for practice, policy and/or changes in individual’s behaviour (real-world impact). Based upon the findings from our research and the intervention, we have already contributed to guidelines for managing sleep during COVID for the British Psychological Society, British Sleep Society, Public Health England, NHS England, the European Sleep Research Society and the Society for Behavioral Sleep Medicine in the USA. Additionally, to date, we have trained over two hundred clinicians in the UK, USA, Japan and Holland on how to use our intervention to help students, front-line healthcare workers, carers and vulnerable populations manage their sleep during the crisis.
Sleep disturbance in young adults who are at risk of suicide are a warning sign of worsening suicidal thoughts, according to new research from Stanford University. These findings held true regardless of the study participants’ current levels of depression.
Suicide is the second leading cause of death in young people in the US and the leading cause in the UK. Having a better understanding of the signs of suicidal thought is important as it could help prevent suicide. Previous research has shown a link between suicidal thoughts and poor sleep, but the Stanford researchers went beyond this research by closely examining which aspects of disrupted sleep predicted suicidal thought.
The researchers examined sleep objectively, using sleep tracking devices, and subjectively, using sleep diaries and records of suicidal thoughts. A group of 50 undergraduate students was selected for the study on the basis that they had recent suicidal thoughts or a history of suicide attempts. The students’ sleep was monitored for seven days continuously. They were also asked to complete a questionnaire – at the beginning, middle (day seven) and end of the study (day 21) – that asked them about the severity of suicidal thoughts, depression, insomnia, nightmares and alcohol use. The researchers found that changes in when the students went to sleep and when they woke up predicted suicidal thought, as did increased symptoms of insomnia and nightmares.
It has long been known that poor sleep, in general, and insomnia, in particular, are associated with a wide variety of mental health conditions. As research in the area advanced it became clear that this relationship was not just an association but rather that insomnia posed a significant risk for the development of many mental health problems, most notably depression.
The researchers objectively measured sleep using sleep tracking devices. fizkes/Shutterstock
A strong association
Over the past ten to 15 years, researchers have widened the scope of sleep and mental health research to investigate the relationship between poor sleep – including insomnia – and an increased risk of suicide. Within this framework various research groups around the world began to examine whether poor sleep was related to increased suicidal thoughts but also whether a person who sleeps poorly is more likely to attempt, or complete, a suicide or not.
It soon became clear that a strong association between poor sleep and suicide existed and that the severity and duration of insomnia symptoms and nightmares were associated with increased suicidal thoughts. Especially interesting is that in almost all these studies the relationship between poor sleep and suicide existed independently of a diagnosis of depression or the number of depressive symptoms experienced, as in the current study. But, as most of this previous research was based on self-reported symptoms (of both sleep problems and suicidal thoughts), it was unclear whether the relationship between poor sleep and suicide was based on how the person actually slept or how they felt they had slept – two surprisingly different concepts. The fact that the Stanford researchers objectively measured sleep is a particular strength of their study.
Three theories
But the reasons for the relationship between poor sleep and suicide have yet to be determined. However, there are three avenues of research which, although still in their infancy, may shed light on why poor sleep is so strongly related to suicide. One, there are significant overlaps between brain circuits that are involved in both emotion regulation and sleep. As such, if sleep is disrupted the likelihood is that mood will also be disrupted, and vice versa. Two, there may be changes in the structure of sleep itself, as a result of poor sleep and insomnia, which makes us more vulnerable to a variety of mood disturbances, including suicidal thought. And, three, the daytime fatigue, caused by poor sleep, affects our ability to think and act rationally.
As yet, we simply don’t know what underscores the relationship between poor sleep and insomnia but, with these avenues in mind, a preventative strategy for suicide is definitely getting closer. And the likelihood is that it will involve the management of sleep.
The Samaritans can be contacted in the UK on 116 123. Papyrus is contactable on 0800 068 41 41 or by texting 07786 209 697 or emailing pat@papyrus-uk.org. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.
Northumbria University Psychology Department 