Do prescription hypnotic medications increase or decrease suicidality?

There has been a growing interest in the association of sleep disturbances with suicidality for 4 decades. Epidemiological and clinical research show that insomnia, hypersomnia, and nightmares are independent risk factors for suicidal behavior. Fawcett et al,1 in a clinical study, suggested that insomnia was one of the “modifiable risks” for suicide. Seven years later, Agarg ˘ un, Kara, et al ¨ 2 showed that not only insomnia but also hypersomnia was associated with suicidal behavior in patients with major depression. With regard to the relationship between dreams and suicide, Agarg ˘ un, Cilli, et al ¨ 3 examined the association between repetitive and frightening dreams and suicidal tendency in patients with major depression. The patients with frequent nightmares, particularly women, had higher suicidality scores and were more likely to be classified as more suicidal than the other patients. A prospective follow-up study also reported that the frequency of nightmares is directly related to the risk of suicide in the general population.4 Interestingly, only nightmares were associated with suicidal ideation, after controlling for depressive symptoms