In a psychiatric emergency department in Paris, 83% of patients experiencing a suicidal crisis reported at least one dream alteration. Bad dreams occurred in 61.9% of participants, nightmares in 52.4%, and suicidal scenarios within nightmares in 35.7%. Nightmares emerged on average 128 days before the crisis, while suicidal-themed nightmares appeared closer, about 16 days before the emergency visit. Over half of patients (54.8%) showed an evolutionary pattern of at least two successive dream alterations. Nightmare severity correlated with insomnia severity and anxiety symptoms. These findings suggest that nightmares may serve as early markers of suicide risk, with systematic assessment potentially enhancing clinical practice.
Sleep disturbances—including insomnia, nightmares, abnormal sleep duration, and circadian rhythm disruptions—are consistently associated with suicidal ideation, suicide attempts, and suicide deaths, independent of psychiatric disorders. Objective markers such as nocturnal wakefulness and REM sleep alterations further support this link. Potential mechanisms involve inflammation, neurotransmitter dysregulation, impaired prefrontal-limbic connectivity, and psychosocial factors like hopelessness and nocturnal isolation. Incorporating sleep-related interview questions, validated questionnaires, and actigraphy into suicide risk assessment may strengthen detection. Interventions targeting sleep, such as CBT-I, sleep medications, and Imagery Rehearsal Therapy, show promise in reducing suicidal ideation.