Treating Insomnia Can Decrease Suicide Risk

Deborah Cowley, MD reviewing Trockel M et al. Sleep 2015 Feb.

Cognitive-behavioral therapy for insomnia reduced suicidal ideation in military veterans.

Sleep disturbance is a risk factor for suicidal ideation and behavior. These researchers investigated whether treatment of insomnia with cognitive-behavioral therapy for insomnia (CBT-I) would decrease suicidal ideation.

The participants, 405 U.S. military veterans with DSM-IV insomnia disorder, completed a course of CBT-I (men, 86%; white, 70%). Patients with bipolar disorder, severe daytime sleepiness, or substance use disorder within the past 4 weeks were excluded. CBT-I included an initial assessment and then ≤5 treatment sessions with modules on sleep restriction, stimulus control, relaxation, cognitive therapy, and relapse prevention.

CBT-I significantly reduced insomnia. At baseline, 32% of patients reported suicidal ideation, compared with 21% after CBT-I, a significant difference. Depression scores also decreased significantly after CBT-I. Decreases in depression severity were associated with reduced suicidal ideation. After depression severity and demographic variables were controlled for, reduction in insomnia severity continued to be significantly related to the decreases in suicidal ideation.

Citation(s):

Trockel M et al. Effects of cognitive behavioral therapy for insomnia on suicidal ideation in veterans. Sleep 2015 Feb; 38:259.