Nightmares and beliefs about sleep are related to suicidal thoughts

This article in the Journal of Clinical Sleep Medicine discusses the relationship between nightmares, beliefs about sleep and insomnia, and suicidal thoughts. Apparently, studies have shown that insomnia symptoms are related to near lethal suicide attempts. Nightmares are also linked to suicidal thoughts and completions.

This study gave questionnaires to patients that presented with suicidal thoughts or attempts. Insomnia symptoms were common in these patients. Nightmares were also present. These symptoms remained significant even after adjusting for the effects of depression - which can increase risk of suicide and insomnia. The researchers analyzed these patients thoughts and beliefs about sleep and insomnia - such as, "if I don't sleep well, I will not be able to function at all the next day."

The findings suggest that the insomnia symptoms themselves were not the determining factor for suicidal thoughts - it was the thoughts about the consequences and causes of insomnia that was related to suicidal thoughts. Nightmares also increased the risk of being suicidal. This makes sense. Many people wouldn't mind insomnia as much if they felt it didn't impact their daytime functioning or possibly affect their health. The researchers noted a sense of hopelessness about insomnia - meaning these insomniacs did not think they ever would sleep better. And therefore, their daytime functioning and how they felt in the daytime would never improve. It reminds me of patients that deal with chronic, unrelenting pain - they can become hopeless about ever living a life without pain.

Unlike chronic pain, however, insomnia can get better with behavioral therapy. Recognizing this is important for physicians and mental health workers, so that they can refer their at risk patients with insomnia for appropriate treatment.

Crying to sleep safe for babies emotional health in the long term

This article discusses research showing that modern day approaches to helping your infant to sleep on their own, do not cause long lasting emotional or physical problems. The methods monitored were controlled comforting, where the parent(s) gradually lengthen the time interval to respond to baby's crying, and camping out in the bedroom.

Behavioral Therapy Improves Sleep and Psychosocial Quality of Life

At the annual meeting of the Pediatric Academic Societies, researchers presented data from a study of 108 families with children (mean age 5.6 years) that had moderate to severe sleep problems based on a survey of parents. Right off, this should raise a flag as to the conclusions, since these children were not officially diagnosed by a physician.

The intervention was an initial 45 minute private consultation with parents at the school, a 20-minute telephone call 10 days later, and a 30-minute private consulation at the school if needed (the study report does not state how many needed that extra 30-minute consultation). The report does not state specifically what the behavioral interventions were or who did them.

The results showed a 74% improvement in the intervention group vs a 53% improvement in the control group in the parents report of their childrens sleep at 6 months. Also, the children in the intervention group had less bedtime delay and resistance, and less daytime tiredness than the control group. The intervention group also had inmproved social and emotional functioning, but no effect on ADHD symptoms.

The authors conclude that a brief, behavioral intervention had significant benefits in the short to medium term, and that it is possible to deliver such an intervention in the school environment. Of note, over half of the patients in the control group got better on their own. But still, behavioral therapy for children can be beneficial, especially for those parents who find it difficult to set limits - one of the most common causes of insomnia in children.

Behavioral Treatment of Insomnia in Older Adults

A study was published in the online version of the January issue of the Archives of Internal Medicine about behavioral treatment of insomnia in older adults. Researchers studied 79 adults (mean age 72, 70% women) with chronic insomnia and common other illnesses. They randomly selected half to receive brief behavioral treatment for insomnia (BBTI) or information control (IC). BBTI consisted of two intervention sessions and two telephone calls. The interventions were reducing time in bed, getting up at the same time each day, not going to bed unless sleepy, and not staying in bed unless asleep. IC consisted of printed educational materials and two telephone calls. Both treatments were administered by a nurse clinician.

BBTI produced a response in 67%, whereas IC had a 25% response. The percentage without insomnia after the intervention was 55% with BBTI and 13% with IC. The BBTI group reported better sleep and health after the intervention, had more improved sleep diaries, and had less insomnia when their sleep was studied at home with wrist-watch actigraphy. There was no difference between BBTI and IC on an in-lab sleep study. This makes sense, as many patients do not sleep as well in the lab, as at home - whether they have insomnia or not.

The study authors concluded that BBTI provides a clinically and statistically meaningful improvement in insomnia that is sustained for six months. Also, since BBTI is not readily available, this study showed that it could be delivered by a nurse with no formal sleep training. This means that more patients could receive effective non-pharmacological treatment for their insomnia.