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Why Insomnia Is Linked To Suicidal Thoughts—And How Therapy Can Help 

Posted on January 23, 2023 by Henry Ford Health Staff
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Within recent years, researchers have identified a connection between insomnia and suicide

Chronic insomnia, or having difficulty falling or staying asleep for three months or longer, is strongly linked to suicidal thoughts and behaviors. But having insomnia for even two weeks—or experiencing lesser, self-reported sleep disturbances—is also linked to an increased suicide risk. Reasons for this are likely multifaceted, but one theory is that lack of sleep negatively impacts someone’s mood and impairs their ability to act rationally.    

“Lack of sleep makes us more vulnerable to feeling overwhelmed,” says Anthony Reffi, Ph.D., a postdoctoral fellow in sleep disorders research at Henry Ford Health. “We act impulsively and can’t think clearly. With little sleep, it can be difficult to deal with life’s daily stressors.” 

How Therapy For Insomnia Can Alleviate Suicidal Thoughts

If insomnia can lead to suicidal thoughts, then can treating insomnia decrease suicidal thoughts? The answer might be yes, according to a recent Henry Ford Health study. The study analyzed data from 658 adults with insomnia who received either digital cognitive behavioral therapy for insomnia (CBT-I) or sleep education. Those who successfully treated their insomnia with CBT-I were more likely to experience fewer suicidal thoughts. 

“While CBT-I didn’t directly prevent the development of new suicidal thoughts, it did help rid patients of their insomnia, which decreased suicidal thoughts,” says Dr. Reffi. “Only 1.5% of patients who successfully treated their insomnia with CBT-I said they still had suicidal thoughts.” 

Digital CBT-I is a standardized program that’s fully automated. You work with an animated virtual therapist who provides sleep guidance based upon data you submit about your sleep patterns. There are six sessions. “The program doesn’t use prescriptions or sleeping aides, which many people are reluctant to use in the first place,” says Dr. Reffi. “You could also do in-person CBT-I, but the fact that this is virtual and fully automated makes it an accessible yet effective treatment.”  

CBT-I Tips To Getting Better Sleep  

One crucial component of CBT-I is stimulus control. “When people develop insomnia, over time, the bed becomes associated with wakefulness,” says Dr. Reffi. “People will worry about what they have to do tomorrow or ruminate over past events. They toss and turn, they take out their phone and scroll through Instagram, which is completely antithetical to sleep. Doing this night after night makes the brain and body come to expect these behaviors when you get into bed.”   

Stimulus control teaches you the bed is only for sleep. If you get into bed and you’re lying awake, get up. Go to a dimly lit room and do an activity that’s not very stimulating, such as reading. When you feel your eyes getting heavy, go back to bed. “It’s about giving up the struggle to sleep because the harder you try, the harder it is to sleep,” says Dr. Reffi. “With stimulus control, you’re creating the conditions for sleep to naturally occur.”

Another important tip, he adds, is to not make up for sleep loss with sleep extension. “Some people think if they get into bed earlier they’ll eventually get enough sleep,” he says. “But it only perpetuates the problem. Your body needs routine. It’s not true that everyone needs eight hours of sleep a night. It’s different for each person and changes depending upon your age.” 

So if you’re trying to force your body to sleep more than it needs, you’ll likely have trouble falling asleep and/or wake up in the middle of the night, and ultimately prevent yourself from getting quality sleep. “Instead, stick to a schedule that has you getting up and going to bed at the same time each day and getting the amount of sleep that leaves you refreshed, productive, happy and able to tackle the day without feeling drained,” says Dr. Reffi.  

While it’s common for everyone to have sleep disturbances from time to time, reach out to your primary care doctor or a sleep specialist if it’s becoming a problem. “If you’ve been struggling with sleep for weeks, months or even years,” says Dr. Reffi, “I’d recommend cognitive behavioral therapy for insomnia.” 


To find a doctor or sleep specialist at Henry Ford, visit henryford.com or call 1-800-436-7936.

Anthony Reffi, Ph.D., is a postdoctoral fellow in the Thomas Roth Sleep Disorders Center at Henry Ford Health.

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