Insomnia Linked to Suicidal Thoughts, High Blood Pressure



By Jacquelyne Froeber
WEDNESDAY, April 1, 2009 ( — Listen up, insomniacs! Tossing and turning into the wee hours may be more harmful than you think.

Two new studies suggest that insomnia may have harmful affects on both the body and mind, including a rise in blood pressure and an increased risk of suicidal thoughts and behavior. “The message is that insomnia is not a minor problem that can be ignored,” says Alexandros N. Vgontzas, MD, director of the Center for Sleep Disorder Medicine at Penn State University.

In the first study published Wednesday in the journal Sleep, Dr. Vgontzas and his colleges studied 1,741 men and women. People with long-term insomnia (a year or longer) and a short sleep time (less than five hours a night) were five times as likely to have high blood pressure as people without insomnia who slept six or more hours per night. People with insomnia who slept five to six hours a night were three-and-a-half times as likely to have high blood pressure as insomnia-free sleepers who snoozed for at least six hours a night.

“Our results are novel because for the first time they show that insomnia is associated with a high risk for hypertension,” Dr. Vgontzas says. “Until now, only sleep apnea has been associated with high blood pressure.” Sleep apnea is a disorder characterized by heavy snoring and upper-airway collapse, in which sleepers snort and gasp for breath, sometimes hundreds of times a night.

Although the exact link between high blood pressure and insomnia is still unclear, Dr. Vgontzas says an increased secretion of the stress hormone cortisol may play a role.

Next page: Why insomnia and suicidal thoughts might be linked

In the second study, a team led by Marcin Wojnar, MD, of the Department of psychiatry at the University of Michigan looked for a link between insomnia and suicidal behavior in 5,692 participants in the National Comorbidity Survey Replication (NCS-R).

Looking at the previous year, the researchers found that people with sleep problems —such as difficulty falling asleep or maintaining sleep, or early-morning awakening—nearly every night were about twice as likely to report suicidal thoughts, suicide planning, or an actual suicide attempt as those with no sleep problems.

For example, about 21 percent of people said they had problems falling asleep (as opposed to waking early or in the middle of the night), and of those people 109 had suicidal thoughts (7.9 percent of people with this type of insomnia), 39 had planned a suicide attempt (2.8 percent), and 26 had made a suicide attempt (1.8 percent). In those who didn’t have trouble falling asleep, the percentages were 1.6 percent, 0.3 percent, and 0.2 percent, respectively. The results were presented this week at the World Psychiatric Association meeting in Florence, Italy, and published in the Journal of Psychiatric Research.

Although certain mental illnesses like depression can cause insomnia, Dr. Wojnar says, the link seemed to exist even after the researchers took into account depression, anxiety, alcohol, substance abuse, or chronic physical illness. “Association between sleep problems and suicidality seems to be fully independent of potentially underlying disease,” he says. “Sleep difficulties pose unique risks for suicidal thought, plans, and attempts.”

Dr. Wojnar says insufficient sleep may have a negative impact on cognitive function, which may result in poor judgment, feelings of hopelessness, or a lack of impulse control. Also, insomnia may affect serotonin, the brain’s “good mood” chemical. Dr. Wojnar estimates that effectively treating sleep symptoms could prevent 20 suicide attempts per 6,000 people.

Next page: What to do if you have insomnia

One in three adults experience insomnia at some point, according to the U.S. Department of Health and Human Services. In addition to difficulty falling or staying asleep, the symptoms can include not feeling well-rested the next day, tension headaches, and worrying about sleep. A lack of sufficient sleep is associated with a slower reaction time and poor job performance, and, in the long term, an increased risk of diabetes, obesity, and poor immune system function.

Women are twice as likely to experience insomnia then men, which may be due to hormonal shifts during menstruation. Other risk factors for insomnia include age (being older than 60) and mental-health disorders like anxiety, depression, and stress.

For some, treatment can be as simple as making lifestyle changes, Dr. Vgontzas says. “Exercising, eating healthy, and avoiding smoking are helpful measures,” he says. “However, a common treatment for insomnia is a combination of medication and psychotherapy, primarily cognitive behavioral therapy.”

Cognitive behavioral therapy includes education in “sleep hygiene,” lifestyle factors that affect sleep. For example, it may help to cut back on coffee late in the day or to take a television out of the bedroom. Other behavioral therapies, including relaxation techniques and light therapy, may also help.

Prescription sleeping pills such as Ambien and Lunesta can be prescribed for sleepless nights, but do not treat the underlying cause of insomnia.

For patients with insomnia and a risk for hypertension, Dr. Vgontzas suggests talking to a primary care physician, psychiatrist, or sleep specialist.

And people with insomnia and suicidal thoughts are also encouraged to seek advice from a physician and a psychiatrist. “Antidepressant medication is most effective when treating both,” Dr. Wojnar says. “Do not wait for symptoms to resolve themselves.”