Nightmares, insomnia, and suicide within a trauma-exposed sample

Psychol Trauma. 2026 May 21. doi: 10.1037/tra0002202. Online ahead of print.

ABSTRACT

OBJECTIVE: The literature is mixed regarding the relationship between nightmares and suicide, with some suggesting that the variance in nightmares is explained by fear of sleep (FoS), insomnia, and/or obstructive sleep apnea (OSA). We add clarity to the literature by examining the relationship between nightmares, insomnia, and suicide within a trauma-exposed sample, while controlling for FoS and OSA.

METHOD: Our sample included 223 trauma-exposed participants who completed an anonymous online survey measuring trauma exposure, insomnia symptoms, nightmare frequency, FoS, suicide cognitions (SCS), and OSA. To examine the predictive power, a stepwise regression model was utilized, where in Step 1, FoS and OSA were the predictors, and in Step 2, nightmares and insomnia were added to the regression model.

RESULTS: In the first step, FoS predicted SCS (b = 0.52, p < .01; F = 13.7, p < .001); OSA did not predict SCS (p = .44). In the second step, nightmares (b = 3.36, p < .05) and insomnia (b = 0.75, p < .001) independently predicted SCS, but FoS was no longer a significant predictor of SCS (p = .43). The model’s second step explained 21% of the variance in SCS (F = 10.57, p < .001). Within our trauma-exposed sample, suicide cognitions were predicted by nightmares and insomnia, while controlling for FoS and sleep apnea.

CONCLUSIONS: These results indicate that insomnia and nightmare frequency are both independently associated with suicide cognitions. In this trauma sample, the relationship of nightmares to suicidal thoughts was not an artifact of insomnia and FoS but directly related. The findings provide rationale for targeting insomnia and/or nightmare interventions to potentially reduce suicidal thinking. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

PMID:42166295 | DOI:10.1037/tra0002202