Sleep Disturbances, Psychosis Symptoms, and Suicidal Ideation in First Episode Psychosis: An Exploratory Mixed-Methods Study

Sleep disturbances are a risk factor for suicidal ideation and are commonly reported amongst individuals experiencing psychosis. Given elevated suicide risk in first episode psychosis (FEP), understanding associations between sleep and suicidality is imperative for informing risk management and intervention. This study explored associations between sleep, psychosis symptoms, and suicidal ideation and the perceptions of those with FEP regarding these experiences. Ten participants experiencing FEP were recruited from Early Intervention services. Participants wore an actigraph for 7 days, completed 3 measures (insomnia severity index, prodromal questionnaire brief, and Beck scale for suicidal ideation), and participated in a semi-structured interview. No significant associations were found between variables, however, descriptive statistics indicated variation in sleep duration, sleep timing, wake after sleep onset, and onset latency. Qualitatively, participants described an extended process of loss, from losing sleep to "losing themselves" and the ability to make safe decisions. Sleep disturbances were considered central to the meaning making of psychosis experiences prior to an acute episode, and as a "trigger" for subsequent experience. Participants discussed reduced emotional control and heightened self-harm or non-suicidal self-injury following sleep disturbances. Participants described a sense of entrapment in their experiences of poor sleep and described suicide as an escape from their current reality. The relationship between sleep and suicidality in FEP warrants further exploration, including understanding of how specific aspects of sleep relate to suicidality, and exploration of the psychological processes in this complex relationship.