Sleep quality and disruptive nocturnal behaviors as short-term predictors of suicidal intent: An ecological momentary assessment study

Background: Emerging research suggests that poor sleep quality and some disruptive nocturnal behaviors (DNBs) may be advance markers of short-term worsening in suicidal intent. However, relationships between many types of DNBs and suicide risk have not been examined, and whether DNBs provide useful information apart from sleep quality in predicting suicidal intent is unknown. This study addressed these critical knowledge gaps by examining associations between sleep quality, DNBs, and next-day suicidal intent in a community sample of adults. Methods: A sample of 237 adults with severe suicidal ideation provided daily indices of sleep quality and DNBs, and suicidal intent 6 times per day for 2 weeks via ecological momentary assessment. Linear mixed models and general linear models were conducted to examine relationships between sleep quality and DNBs with measures of average severity of suicidal intent and fluctuations in intent over time. Results: Poor sleep quality and specific DNBs (sleep disruptions due to general nervousness, trauma-related memories and/or nightmares interrupting sleep, and non-trauma-related anxiety or panic) predicted more severe suicidal intent in multivariate models. Only poor sleep quality predicted within-day variability in suicidal intent. Conclusions: These findings suggest that monitoring sleep quality and specific DNBs may be a useful indicator of short-term risk for worsening in suicidal intent.