Understanding the Role of Sleep on Suicidal Ideation in Active-Duty Service Members: Implications for Clinical Practice

Suicide is a significant public health concern, particularly within the U.S. military. Sleep difficulties are hypothesized to elevate risk, yet this association is not well understood. Presently, there is some support for a positive association between subjective reports of sleep disturbances and suicidal ideation (SI); however, research regarding the relation of SI and objective measures of sleep is sparse. The present study aimed to examine the association of subjective and objectives measures of sleep on SI in a sample of active-duty service members and provide recommendations to changes in clinical care. Data were obtained from the National Intrepid Center of Excellence's clinical database. Patients (N = 1,550) were predominantly male, Navy/Coast Guard, and enlisted rank, with a mean age of 38 years. Patients underwent a sleep study and completed a battery of measures as part of standard clinical care. SI was coded as a binary variable, and odds ratios were calculated using logistic regression. Of the 14 objective sleep indices examined, REM latency and time in sleep stage N2 were related to SI. Subjective reports, including sleep quality, sleepiness, bad dreams, and traumatic bad dreams and nightmares, were all significantly associated with increased odds of SI. Notably, subjective reports of sleep were the only measures with meaningful odds ratios, with traumatic bad dreams producing the greatest odds ratios. The present findings suggest subjective reports of sleep disturbance are important when evaluating SI in active-duty service members and may represent an important point of intervention for patients experiencing SI. Clinical Impact StatementThe present study adds to the literature on the role of sleep, both objective and subjective, on suicidal ideation in service members. These results provide support for the need to evaluate self-reported sleep disturbances during suicide risk assessments, with a particular focus on the need to consider bad dreams and posttraumatic nightmares.