By Julia Merrill NP and Matthew Goldenberg D.O.
Thoughts of being better off dead and even suicidal thoughts can happen to anyone for a number of reasons. These types of thoughts can be fleeting; however, when they become more frequent or more intense and difficult to cast away, it can be very distressing. Individuals with mental illness, including addiction, are at a greater risk for suicidal thoughts and actions. [1,2] One aspect of both addiction and mental illness that may contribute to suicidal thoughts is poor sleep. [3,4] The good news is that improving sleep is one area where interventions may significantly decrease risk of suicide.
Being unable to sleep can be a sign of both substance abuse and/or mental health issues. Conversely, sleeping too much can be a sign of both as well. In both active use, and in periods of withdrawal, substance use disorders often co-occur with depression and other mood disorders.  Active depression is one of the largest risk factors for suicidal thoughts. The strong connection between depression and addiction highlights one of the less obvious dangers of addiction. The best way to prevent addiction-fueled depression is to get treatment as soon as possible.
Beyond addiction and depression, sleep disorders often occur alongside other mental illnesses such as PTSD, ADHD and Anxiety Disorders. Insomnia and lack of sleep can exacerbate mental illnesses, which can cause disrupted or excessive sleep. Problems with sleep may include irregular sleep patterns, an inability to sleep, or sleeping for too long. Treatments often involve sleep medications or supplements. Improved sleep hygiene may also help. This includes the recommendation of a nightly routine. Non-medication options are always a good idea. However, in some cases, medications used for sleep can lead to addiction.
It’s a good idea to establish a sleep routine. It could look something like this: about one hour before bed begin winding down, play some calming music, dim the lights, change into your pajamas, brush your teeth and then do something relaxing (meditation, prayer, light reading, listen to calming music). The goal is to not do anything activating or stimulating the last hour before you want to go to sleep. The goal of the routine is to train your brain to anticipate sleep and to wind down prior to getting into bed and putting your head on the pillow. Remember, it’s only a routine if you do it each night. If you are unable to obtain restful sleep by changing your sleep hygiene and bedtime routine, you should speak to your doctor or a psychiatrist.
The most important part of facing addiction, mental illness and/or trouble sleeping is seeking help. Too many people go without treatment and watch their symptoms get worse as time passes. One risk of letting your symptoms go untreated is suicidal thoughts. As mentioned, this is preventable with treatment.
Some people turn to self-medication in an effort to cure their sleep problems and/or other symptoms of mental illness. Self-medication describes when a person abuses a substance in an effort to control the symptoms of an illness. It can be very common among people with mental illnesses who are not receiving proper treatment. Sadly, both the untreated mental illness and the possible risk of developing an addiction increase the risk of suicidal thoughts in those who rely on self-medication.
The appeal of self-medication, and in many cases what reinforces abuse of drugs and alcohol, is that they may seem to help ease the symptoms of mental illness, pain and/or suffering in the short term. However, the long-term results of drug and alcohol abuse can be devastating.
If you recognize that you or a loved one is struggling with self-medication, addiction, mental illness, or a combination of all or any of the above, please take action. The longer your loved one struggles, the more at-risk for adverse outcomes, including suicide, they become. Treatment is not a luxury; it is an absolute necessity.
Getting help for a loved one can be difficult if they are resistant. Do not give up! Your love and support can make all the difference in whether or not they get the treatment they need.
Experiencing suicidal thoughts first hand, or knowing someone you care about is at risk for suicide, can be a frightening revelation. However, it is important to remember that knowing the risk factors is half the battle. If you are able to recognize the signs, you have an opportunity to get the help you need. Once proper treatment is secured and recovery is under way, a happy and healthy life is on the horizon.
Julia Merrill is a retired nurse on a mission. She wants to use information to close the gap between medical providers and their patients. She started BefriendYourDoc.org to do just that. The site offers an abundance of information from tips on finding the right medical care to help with dealing with insurance companies to general health and wellness advice and more.