Insomnia and Hypnotic Medications are Associated with Suicidal Ideation in a Community Population

Abstract

Suicidal ideation (SI), a significant predictor of suicide, is associated with sleep disturbance, which is seldom assessed using stringent diagnostic criteria and validated sleep instruments in community samples. Cross-sectional data, including sleep diaries and validated instruments, from 767 community adults were used to identify variables associated with SI and subsequently entered into a regression model to predict SI. Suicidal ideation was endorsed by 9.3% of the sample. This group differed from non-ideators on several variables, but only insomnia diagnosis, depression severity, and hypnotic medication use predicted SI. Findings confirm an association of insomnia with SI using stringent criteria and controlling for depression. If treating insomnia is a conceivable pathway to reduce SI, the apparent risk posed by hypnotics may limit treatment options.

Keywords:

• insomnia
• sedative-hypnotics
• sleep
• sleep disturbance
• suicidal ideation
• suicide

Acknowledgments

W. Pigeon conceived of and took the lead on all aspects of the project. J. Woosley entered and checked data and assisted with writing/editing the manuscript. K. Lichstein contributed to study design, data interpretation and writing/editing the manuscript and conducted the parent study from which all data for the current study were derived.

W. Pigeon is an employee of the Veterans Health Administration which, in part, supported work on this manuscript.

The authors’ views or opinions do not necessarily represent those of the Department of Veterans Affairs or the United States Government.

W. Pigeon reports a consulting agreement with Purdue Pharma, LLP and book royalties from Ivy Press, Inc.

J. Woosley and K. Lichstein report no conflicts of interest.

Notes

Note. ^a Fishers exact test for bivariate variables and independent samples t-test for continuous variables.

SI = Suicidal Ideation; ESS = Epworth Sleepiness Scale score; Wake after Sleep Onset; STAI = State-Trait Anxiety Inventory trait score; BDI-19 = Beck Depression Inventory score absent the sleep and suicide items.

Note. The following variables were entered in step 1 and subsequently removed in the following order: mean sleep latency, Insomnia Impact Scale score, gastrointestinal disorder, mental health condition, Fatigue Severity Scale score, body mass index, chronic pain condition, mean sleep efficiency, mean number of awakenings per night, Trait Anxiety score, age, neurological disorder, nocturnal legs jerks, and sleepiness attacks.

BDI-19 = Beck Depression Inventory score absent the sleep and suicide items.

Hypnotic use nights = total number of nights on which hypnotic medications were used during the two week sleep diary recording period.

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