Sleep disorders in children linked to suicidal thoughts and behavior two years later

Children who have a lot of trouble sleeping are at increased risk of developing suicidal thoughts and behavior as they enter adolescence, according to a new study led by Stanford Medicine.

The research, published recently arrived JAMA network openedfollowed more than 8,800 young people aged 9 and 10, none of whom had suicidal thoughts or behavior at the start of the study.

The data showed that children with frequent or severe sleep disturbances were more than twice as likely as sound sleepers to develop suicidal thoughts and behavior over the following two years. Frequent nightmares carried a particularly high risk.

Understanding the links between poor sleep and suicide is important because sleep problems provide a golden opportunity for parents and doctors to intervene, according to Stanford Medicine suicidologist and founder of the Stanford Suicide Prevention Research Laboratory Rebecca Bernert, Ph.D. , senior of study. author.

Although the relationship between sleep and suicide risk is likely complex, and it is difficult to say whether sleep problems lead to suicidal thoughts and behavior or simply reveal a pre-existing vulnerability, sleep nevertheless provides a uniquely useful window into mental health.

Sleep problems are easy to recognize, aren’t stigmatized in the way that many mental health problems are, and are highly treatable, Bernert said. Additionally, improving one’s sleep has several benefits.

“This risk factor provides a gateway to treatment, whether for overall well-being, to prevent or improve depression, or to specifically reduce the risk of suicide,” says Bernert, assistant professor of psychiatry and behavioral sciences. “This way I see so much hope in sleep for a lifesaving opportunity.”

Perfect storm of sleep changes

As adolescence begins, sleep patterns change. Accelerating brain and physical development, sending the body into an aggressive growth spurt, increasing children’s need to sleep nine or more hours per night.

At the same time, puberty shifts the body clock to “night owl” patterns, causing teens to fall asleep and wake up later. Adolescents also face new responsibilities that can disrupt sleep: more homework; a busier social life; and perhaps early morning sports practices or classes.

“It’s a perfect storm,” Bernert said.

While these changes are normal and not a cause for alarm, Bernert’s team wanted to investigate whether sleep patterns predict mental health risk as young people transition from late childhood to early adolescence, where research remains relatively rare.

The researchers had drawn links between sleep problems and the risk of suicide among young and older adults, as well as among at-risk groups, including military veterans. Sleep can also be disrupted in mental health conditions linked to suicide risk, such as post-traumatic stress disorder, anxiety, and depression, but studies have not evaluated the relationship between disrupted sleep and suicidal behavior in late childhood.

The researchers used data from an ongoing national study, the Adolescent Brain Cognitive Development Study, which is tracking the maturation of more than 10,000 American children starting at age 9 or 10. Bernert’s team analyzed data from 8,807 young people who had completed a two-year course. control around the age of 12 years.

Baseline data included information provided by participants’ parents during a brief survey designed to index common sleep disorders. Researchers also evaluated different types of sleep problems, including difficulty falling or staying asleep; sleep breathing problems, such as sleep apnea; nightmares; and daytime sleepiness – as some examples.

Parents also answered questions at the beginning of the survey about their family’s demographics, the child’s level of anxiety and depressive symptoms, and factors such as a family history of depression and the amount of conflict in the family. Children answered questions about parental control, such as how many parents knew where they were and how often the family ate together.

At baseline and at two-year follow-up, the child and parent completed a detailed questionnaire about the child’s mental health, including questions about four levels of suicidal thoughts and behaviors, ranging from passive thoughts (thinking you would be better off dying are) to having suicidal thoughts and behavior. attempted suicide. Because the study was designed to evaluate emerging suicidal thoughts, the analysis did not include children who had suicidal thoughts or behaviors at baseline.

Nightmares increase the risk

More than half of the children had minimal sleep disturbances when the study began. Two years later, 91% of children in the study had no suicidal thoughts or behavior.

Children with high levels of sleep disturbance at baseline were 39% more likely than children with minimal sleep disturbance to have suicidal thoughts or behavior two years later, and children with severe sleep disturbance were more than two and a half times as likely (268% more). likely) to report suicidal thoughts or a suicide attempt before the age of 12.

Overall, almost a third of children who had a serious sleep disorder at the start of the study showed some degree of suicidal thoughts or behavior two years later.

A child’s baseline levels of anxiety and depression, family history of depression and family conflict were all associated with a greater likelihood of suicidal thoughts and behavior at age 12. In comparison, more parental supervision was protective and linked to a lower likelihood of suicidal thoughts and behavior. .

“Setting bedtimes by parents can be helpful,” Bernert said, adding that the study suggests that other simple parenting practices — checking in with your kids regularly, knowing where they are, having regular family dinners — can provide meaningful benefits to children’s mental health. children.

The sleep problems most strongly associated with suicide risk were nightmares, excessive daytime sleepiness, and difficulty falling and staying asleep. Among these risk factors, nightmares stood out: Children with severe, daily nightmares at the start of the study were five times more likely to have suicidal thoughts or behavior two years later.

“There’s a reason for that,” Bernert said. “One of the fundamental functions of REM sleep – or dreaming – has to do with emotion regulation and processing of emotional information. Although occasional disturbing dreams or nightmares are normal and considered adaptive, nightmares that are intense, disturbing, and highly repetitive can disrupt this processing. We also believe they can serve as a unique opportunity for intervention.”

The good news is that there are effective, drug-free treatments for insomnia and nightmares, Bernert said. For example, the treatment of “dream re-scripting” (imago rehearsal therapy) has been shown to be an effective treatment for nightmares. Treatment starts with sleep education; patients learn that we all have nightmares sometimes, and that frequent nightmares are a behavior we can unlearn.

The doctor then engages the patient in guided imagery exercises to rescript the dream, providing a better story or a new ending to their dream. Likewise, insomnia in children and adolescents is easily treated using a brief behavioral intervention (cognitive behavioral therapy for insomnia).

Better screening tools for pediatricians

In addition to setting the stage for more research into the links between sleep and suicide risk, Bernert hopes her team’s findings can help pediatricians look for early signs of mental health problems in their young patients.

Simple tools already exist to help doctors and parents monitor for sleep problems in children, she noted, such as a short questionnaire using the acronym BEARS (for bedtime, excessive daytime sleepiness, waking during the night, regularity and duration of sleep, and snoring). ) to remind people what facets of sleep disorders to pay attention to – and to prioritize overall sleep health.

“Sleep problems are unique in terms of their visibility,” she said, noting the usefulness of a risk factor for mental health problems that has no stigma compared to other known risk factors for suicide.

“Sleep is visible to a parent, a loved one, or a pediatrician. A developing teen may be willing to talk about their sleep even if they feel less comfortable talking about their mood or depression. This makes sleep a potential gateway to treatment and overall well-being – while offering hope for prevention.”