Suicide and Sleep Disorders: The Role of Insomnia, Nightmares, and Circadian Disruption.
Omofolarin Debellotte, Amuksha Ravindra Shetty, Yuzhu Wang, Ayesha Amin, Vikdeep Mann, Morolayo Fadayomi, Pranati Gudipati, Haidy Hanna, Libina Karippaparambil, Manju Rai
Cureus July 9, 2026 DOI: 10.7759/cureus.112319 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Narrative review Cross-sectional Peer reviewed |
|---|---|
| Interventions | Cognitive behavioral therapy for insomnia (CBT-I) imagery rehearsal therapy chronotherapeutic approaches |
| Topics | Dreaming |
| Keywords | Sleep disorders Insomnia Nightmares Suicide prevention Chronotherapy Suicidal ideation Neurobiological mechanisms Emotional dysregulation Circadian rhythm disruption |
| Key findings | The authors argue that insomnia, nightmares, and circadian disruption are underrecognized contributors to suicidal ideation and behavior, acting through hyperarousal, hopelessness, impaired emotion regulation, HPA dysregulation, serotonergic imbalance, and clock-gene alterations. They contend that CBT-I, imagery rehearsal therapy, and chronotherapeutic approaches improve sleep and may mitigate suicidality, and recommend routine sleep and circadian assessment in suicide risk evaluation, while cautioning that mostly observational, heterogeneous evidence limits causal inference. |
Abstract
Suicide remains a leading global cause of preventable mortality, with sleep disturbances, particularly insomnia, nightmares, and circadian disruption, emerging as critical yet underrecognized contributors to suicidal ideation and behavior. This narrative review synthesizes current evidence on the multifaceted links between sleep disorders and suicidality, integrating findings from epidemiological, neurobiological, and interventional studies. Insomnia contributes to suicide risk through pathways of hyperarousal, hopelessness, and impaired emotion regulation, while nightmares are associated with increased risk of suicidal ideation and attempts, potentially exerting an effect distinct from other sleep disorders. Circadian misalignment, including shift work and evening chronotype, further exacerbates vulnerability through neuroendocrine and molecular alterations involving the hypothalamic-pituitary-adrenal axis, serotonergic imbalance, and disrupted clock gene expression. Shared biological mechanisms, such as inflammation, hypothalamic-pituitary-adrenal (HPA) dysregulation, and serotonergic depletion, intersect with cognitive-emotional deficits, compounding risk. Clinically, interventions such as cognitive behavioral therapy for insomnia (CBT-I), imagery rehearsal therapy, and chronotherapeutic approaches have demonstrated efficacy in improving sleep continuity and mitigating suicidality. Routine assessment of sleep quality and circadian patterns should be integrated into suicide risk evaluation across psychiatric and primary care settings. Future research incorporating objective sleep measures, biomarker profiling, and digital monitoring platforms may enable precision risk stratification and early intervention. However, the current evidence base is limited by heterogeneity in study designs, the predominance of observational and cross-sectional studies, and potential confounding from psychiatric comorbidities, warranting cautious interpretation of causal relationships. By addressing sleep as a core modifiable risk factor, clinicians can move toward a holistic, biologically informed, and preventive model of suicide care.
Comparable studies
Other narrative reviews on dreaming, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| The cognitive neuroscience of lucid dreaming | 2019 | Review | |
| Sleep and dreaming are for important matters | 2013 | Review | |
| Nightmare Disorder and Isolated Sleep Paralysis | 2020 | Review | |
| My Dream, My Rules: Can Lucid Dreaming Treat Nightmares? | 2019 | Review | |
| Dream Recall: State or Trait Variable? Part I: Model, Theories, Methodology and Trait Factors | 1996 | Review |
Citations in the library
Cites 5
- Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms Sleep July 2, 2020
- The mediation effects of nightmares and depression between insomnia and suicidal ideation in young adults Scientific Reports April 26, 2024
- Management of nightmares in patients with posttraumatic stress disorder: current perspectives. Nature and Science of Sleep November 26, 2018
- Nightmares as predictors of suicide: an extension study including war veterans. Scientific Reports March 15, 2017
- Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness. Journal of Clinical Sleep Medicine March 1, 2016