The risk of suicide spikes in the middle of the night. AZ sleep researchers want to figure out why

Many of us have had the experience of lying in bed in the middle of the night, trying desperately to fall asleep and not being able to.

Now, researchers at the University of Arizona will be studying how being awake at that hour can impact our decision-making abilities — and spoiler alert, it’s generally not in a good way.

The five-year project will examine what’s known as the "mind after midnight" hypothesis with a nearly $4 million grant from the National Institute of Mental Health.

Dr. Michael Grandner is director of the Sleep and Health Research Program at UA and director of the Behavioral Sleep Medicine Clinic at Banner University Medical Center Tucson. He joined The Show to talk about the research he and his colleagues will be doing.

Kris Hanning

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Handout

Full conversation

MARK BRODIE: Michael, let’s start off with this "mind after midnight" hypothesis — what exactly is it?

DR. MICHAEL GRANDNER: Yeah, the whole point is that when you're awake in the middle of the night, when your brain wants to be asleep and your body wants to be asleep, but you're not, even though you're awake, you're not really your best self.

You're not in the place where you can make the best decisions, you're not processing information ideally, you're not emotionally regulated in the right way.

And it's not a sleep deprivation issue. And it's not just a circadian rhythm issue. It's a combination of a bunch of things where you could be fine during the day. It's just there's this vulnerable period in the middle of the night where we just, you know, we're idiots. We don't make good choices. We blow things out of proportion, we freak out about things we really shouldn't. And there's a science behind this.

MARK BRODIE: Well, so I think it would maybe not be a surprise to any of us who have been lying awake at like 3 in the morning that maybe that's not when we're at our best selves.

What are you hoping to learn about maybe why that is and why we're not maybe making the best decisions — if it's not because we're just overtired?

DR. MICHAEL GRANDNER: Right, that's the thing. It's that our hypothesis is that there's a combination, there's like a perfect storm of bad decisions that are happening in the middle of the night. Because the parts of your brain that are involved in emotional decision-making, for various reasons, might not be functioning properly during the night because of both the combination of wakefulness where the brain wanted sleep. But at the same time, you're in the the 24-hour circadian rhythm, the part of the day where the brain is not supposed to be processing that information, and so it's not efficient at doing so.

And so our hypothesis is the types of decision-making, especially emotional decision-making, impulsivity, those sorts of functions are going to be worse in the middle of the night than they are during the day, even if you're not sleep-deprived. And that's what we're trying to look at.

And in particular, we're looking at the emotional piece. because the motivation for this study, the reason we were able to make a case that this was critical to fund, was because we discovered a bunch of years ago ... little almost 10 years ago now, that suicide spikes in the middle of the night —about four times higher than you would expect by chance alone. That it's much more likely to occur in the middle of the night than during the day.

And we were trying to figure out the reasons why. And wherever we look in the population, not only do we see this, we also see that it's tied to all kinds of things that are unhealthy choices. I mean, similarly, nobody craves a salad at 2 in the morning either.

I think that — and our hypothesis is that this is all connected. It's all connected to this same system, but the fact that suicide is a major public health problem, and the solutions we have are just not good enough, we came up with an idea that says, look, this is happening in the middle of the night. Let's understand what is special about the middle of the night that's leading to this vulnerability that we can then help address it later.

MARK BRODIE: Well, I wonder then, when you talk about addressing it later on, like would that do you envision that as being helping people to actually fall asleep? Or is it maybe more a matter of if somebody is going to be lying awake or, you know, sitting on the couch awake at at 3 in the morning, to help them sort of regulate their emotional thinking so that they don't make a poor choice?

DR. MICHAEL GRANDNER: All of the above. Yeah, that's the idea. So the way this works is before we can target something, we have to know where to aim. And that's the point. The study we're doing now is all about, where should we aim our potential solutions?

MARK BRODIE: Right. Is it possible that there's sort of a a vicious cycle going on where people who are not able to sleep and sort of, you know, you often hear, you know, "my brain is too active, you know, I have I'm making lists in my head," or "I just can't relax, I can't rest my brain."

Is there possibly a correlation between, you know, some of these emotional decision-making regulations that that you think are causing problems here, and the fact that some of these folks can't actually fall asleep?

DR. MICHAEL GRANDNER: That's actually where all this started. It started in thinking about insomnia. I mean, it widened to it might be more than then insomnia, but it started about insomnia. So why is it that —I mean, if you go back decades, what you will find is, this is where it started with suicide risk where what you find is people with insomnia have a tripled risk of not only thinking about suicide, but actually taking action on it.

And we were alarmed as researchers. We were — there's a group of us who were alarmed by this, and we wanted to get creative and think about, what are we missing? How do we better answer this question?

And which led to this hypothesis, and I got to give credit to Dr. Michael Perlis at the University of Pennsylvania, where this was originally his idea, and he's a collaborator on this project, too. But he had this idea of, what if it's just bad to be awake when your reason sleeps, your ability to reason through things is still asleep? What if that's part of the problem?

That, like you said, some people have insomnia and that insomnia leads them to be awake in this it puts them in a bad place at a bad time. Once they're there, that's where some of the risk is. Now, in people who have insomnia, we have good solutions already, but it's not enough because some people still wake up in the middle of the night and there's nothing you can do about it. Some people still are working shifts, some people, you know, will experience this even occasionally, and then what do we need to do to fix that?

MARK BRODIE: So in the study, are you mostly looking to have participants who have insomnia? Are you looking for folks who are occasionally can't fall asleep or wake up in the middle of the night and can't can't get back to sleep? What what do you imagine the participant, sort of, ratio to be there?

DR. MICHAEL GRANDNER: Yeah, that's an excellent question, because the answer is a little counterintuitive. We're not specifically looking for people with sleep problems. We want people when they come into the lab, we want them, you know, the first night in the lab, they're actually, they actually get a full night of sleep.

We want them to be relatively well-rested the next day when they do some of these tasks. We don't want them to be super tired. And we want them to be able to sleep at night.

And so we're we're looking for people who could sleep — fine. But ... when you wake up, maybe you're not your best self. We think this is actually a normal process. You don't have to have insomnia to be awake during the night and have it affect you.

You know, you could be someone who sleeps great every night, but then, I don't know, the dog starts barking and it wakes you up in the middle of the night, and then maybe you have trouble getting back to sleep, and then you start thinking there are worrying.

Like, this could happen to anybody. We're actually looking for mostly just people who are interested in this. It turns out that the people who are the most interested are some of the ones who are struggling with some of this. And so some of those people would qualify, but some of those people actually, they actually need to get their sleep problem treated before they can come in because we want to study what happens in sort of a normal situation.

MARK BRODIE All right, we'll have to leave it there. That is Dr. Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona. Michael, thanks so much, I really appreciate it.

DR. MICHAEL GRANDNER: Oh, you're very welcome. Thank you.