Suicide is a huge issue when dealing with bipolar disorder. It’s not something people like to talk about, but it’s the 10th leading cause of death in the United States, so it’s worth a conversation or two. People with bipolar disorder are especially vulnerable. They are 20 times more likely to commit suicide than the general population. There are a few reasons for this including a high number of depressive cycles, comorbid substance abuse problems, psychosis and impulsivity. Another factor not often considered when discussing suicidal ideation is sleep disturbance.
People with multiple sleep problems are almost three times as likely to attempt suicide, and bipolar disorder is associated with several sleep problems. The most common are sleeplessness, insomnia and daytime sleepiness.
Sleeplessness occurs mostly during manic phases. Patients can go days without sleep and not feel tired. Sleeping for less than five hours per night has shown an increase for suicide attempts. In one study, patients who had recently experienced sleepless were about 15% more likely to make serious attempts on their lives.
Insomnia can occur almost nightly during depressive episodes. It includes problems falling asleep, problems staying asleep and waking early in the morning. Insomnia is linked to causing or worsening depressive episodes, which can lead to suicidal thoughts. However, there is evidence that the severity of the depressive episode does not necessarily predict the risk of suicide. So, just because a person is only moderately depressed doesn’t mean they are less likely than someone with severe depression to attempt suicide.
Daytime sleepiness (drowsiness and nodding off) can be a symptom of depression, a product of insomnia or just a general lack of sleep. Patients exhibiting daytime sleepiness are more susceptible to suicidal behavior than those who do not. They also tend to have longer depressive episodes.
For those at risk for suicide, attempts are disproportionately made at night. There are two hypotheses as to why this is the case. First, social support is generally less available at night. Without a friend or family member to help walk a patient back from the brink, an attempt may become more likely.
Second, insufficient sleep can also cause problems with cognitive functioning. That is, problems with attention, memory, decision making and impulsivity. It’s easy to connect poor decision making and impulsive behavior with suicide attempt, especially when considering those who have problems staying asleep at night are less likely to make plans for suicide but are more susceptible to attempting suicide.
If you are considering suicide there are steps you can take to help.
- Call a crisis hotline. They are there 24/7 for support.
- Go to the ER. Most are equipped to handle psychological emergencies.
- Call your doctor. They can give more personal direction and adjust your meds if necessary.
- Tell someone. If you are unable to get help for yourself, ask someone to do it for you, even if you think they don’t care.
Image credit: Jacob Stewart