Do Behavioral Sleep Interventions Reduce Suicidal Risk?

Suicide represents a global public health crisis, ranked among the leading causes of mortality worldwide. In 2022, it was the eleventh leading cause of death in the United States, with over 49,000 recorded cases. Among the identified risk factors, sleep disorders occupy a central role, as confirmed by numerous studies and meta-analyses. This research shows that sleep disturbances often precede the emergence of suicidal ideation and risky behaviors, highlighting their potential role in suicide prevention.

A recent narrative review examined the effectiveness of behavioral interventions targeting sleep to reduce suicidal risk. To date, twelve studies have been published on the subject, primarily focusing on cognitive behavioral therapy for insomnia (CBT-I). The results are mixed: six studies observed a significant reduction in suicidal ideation with moderate to large effect sizes, two reported short-term or small effects, and four detected no impact.

The interventions studied vary in format and target population. Some used digital versions of CBT-I, such as a study involving 1,149 online participants, which showed an immediate decrease in suicidal ideation after the intervention, but without long-term maintenance of benefits. Other research, conducted among young Chinese individuals or veterans at high suicidal risk, revealed moderate or non-significant effects. One study of depressed patients even found a higher remission rate of suicidal ideation in the control group receiving sleep hygiene education compared to the CBT-I group.

The underlying mechanisms suggest that improving insomnia symptoms may mediate some of the effects on reducing suicidal ideation. For example, a study of 658 adults showed that remission of insomnia through digital CBT-I was associated with a decrease in suicidal ideation, both in participants initially affected and those without a history.

However, this research remains limited. Most studies focus on suicidal ideation as a secondary outcome, often with small and non-diverse samples. No study has yet evaluated the impact of these interventions on suicide attempts or deaths by suicide. Additionally, underrepresented populations, such as youth, the elderly, or those with neurodevelopmental disorders, are rarely included.

Future directions include developing interventions that combine CBT-I and suicide prevention strategies, using more precise measurement methods such as actigraphy or ecological momentary assessment, and expanding samples to better reflect demographic diversity. The authors also emphasize the need to study specific populations, such as autistic individuals or those with ADHD, who experience both frequent sleep disorders and increased suicidal risk.

In conclusion, while behavioral sleep interventions offer a promising approach to suicide prevention, their effectiveness remains to be confirmed by more robust and inclusive studies. Their integration into prevention strategies could, in the long term, complement existing measures and significantly reduce the burden of suicide.

Bibliographie

Source de l’étude

DOI : https://doi.org/10.1007/s40675-026-00360-4

Titre : Behavioral sleep interventions to reduce suicide risk: Existing research and future avenues

Revue : Current Sleep Medicine Reports

Éditeur : Springer Science and Business Media LLC

Auteurs : Annabelle M. Mournet; Evan M. Kleiman