Suicide, Nightmares, and Fentanyl

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Article posted by Rachel Wilborn, M.A., LMHCA

Sleep is supposed to be a state of healing to eventually wake up with a fresh start. However, the scary reality of sleep is not knowing if you or someone you love will ever wake up. Sleeping is one of those things that humans seem to take for granted, like breathing; it is something we all need to function and survive, but it is almost entirely out of our control. What if sleep betrays us? What if the thin veil between nightmares and reality becomes so blurred that we start to question which is which?

Fentanyl has emerged as one of the most potent synthetic substances in recent memory (Han et al., 2019; Jacka et al., 2020). Unfortunately, it’s dangers are not limited to those that willingly consume; injuries and deaths from accidental or second-hand exposure are on the rise (Han et al., 2019; Jacka et al., 2020). We may not always be able to know if and when someone is exposed to, or “poisoned” by, fentanyl, but recent research now shows fentanyl to have a relationship with sleep problems, such as nightmares (Dimsdale et al., 2007; Hochheimer et al., 2024; Kmiec et al., 2023). Even worse, nightmares play a part in creating a vicious cycle of dependency and increased risk for suicide (Agargun & Beşiroğlu, 2005; Andrews et al., 2020; Ferrie et al., 2011; Sjöström et al., 2007; Titus et al., 2018).

This means recognizing the connection between fentanyl, nightmares, and suicide, is not just left to research psychologists for academic study – it is a matter of life and death. Luckily, changes in our sleep can give us, or others close to us, early warning signs that something might be wrong; and if we know what to look out for, maybe we can fix it in time.

Fentanyl Ruins Sleep

Fentanyl belongs to the opiate family of drugs, and has powerful pain-relieving properties (Han et al., 2019; Jacka et al., 2020). However, it significantly impacts the natural sleep cycles, particularly the Rapid Eye Movement (REM) phase, which increases vivid and disturbing nightmares (Dimsdale et al., 2007; Hochheimer et al., 2024; Kmiec et al., 2023; Solms, 2000 Zhao et al., 2018). As was mentioned earlier, increases in nightmares increase dependency on fentanyl (Ferrie et al., 2011; Titus et al., 2018). To be clear, these are not bad dreams as a random side effect of the drug; these are directly tied to future struggles with depression and anxiety, both of which begin the journey to suicidal ideation (Agargun & Beşiroğlu, 2005; Andrews et al., 2020; Ferrie et al., 2011; Sjöström et al., 2007). Fentanyl leads to nightmares; nightmares lead to scary thoughts during the day that worsen mental health… and that leads people right back to needing fentanyl for relief.

Nightmares and Suicidal Ideations

Chronic, untreated nightmares have long been warning signs of future suicidal thoughts or behaviors:

  1. Vivid and disturbing nightmares can lead to sleep deprivation (Agargun & Beşiroğlu, 2005).
  2. Over time, sleep deprivation devolves into depression, anxiety, and even dissociations (Andrews et al., 2020).
  3. Today, a popular coping mechanism for sleep problems is fentanyl (Jacka et al., 2020).
  4. Fentanyl makes nightmares scarier, which can push someone over the edge (Kmiec et al., 2023).

Scarier is those that have been unknowingly exposed to, or poisoned with, fentanyl may have no other explanation for their increasing nightmarish sleep. Sudden onset of sleep disturbances, especially nightmares, are warning signs we can be aware of to support others getting screened for fentanyl exposure.

Suicide and Hormones

To understand specifically how this cycle of nightmares, opioids, and suicide continues, we need a basic understanding of hormones. During sleep, our mood hormones (dopamine, serotonin, and norepinephrine) are already reduced (Dimsdale et al., 2007; Hochheimer et al., 2024). If these hormones are reduced further to unhealthy levels before sleep, such as with fentanyl, they have been directly linked to intense nightmares (Kmiec et al., 2023; Puglisi-Allegra et al., 1991). When the nightmares become chronic, emotional distress about the nightmare’s content or intensity can begin to set in, which is one of the main reported reasons why many begin to use opioids, like fentanyl, for relief (Hochheimer et al., 2024; Kmiec et al., 2023). Therefore, self-medicating with fentanyl triggers our brain’s reward system (mesolimbic dopaminergic or ML-DA) by cycling between use and withdrawal with sleep deprivation and daytime weariness (Dimsdale et al., 2007; Kmiec et al., 2023; Perogamvros et al., 2015).

A hypersensitive reward system promotes impulsive behaviors; and when those impulses are met, the body floods dopamine and noradrenaline, which have been measured after suicide to be at extremely toxic levels (Arranz et al., 1997; Perogamvros et al., 2015; Ryding et al., 2008). Therefore, fentanyl is not just nightmare fuel; it chemically changes the brain to make suicide more imminent.

What Can We Do?

Now that you know how it is all connected, here is what to look out for:

  1. Monitor Sleep – if you or a loved one have sudden changes in nightmares or other sleep disturbances, it could be that you have been accidentally exposed or poisoned. Seek help.
  2. Encourage Journaling – a dream journal to track frequency and severity will not only promote good sleep hygiene, it can be used to help figure out when and where exposure may have happened.
  3. Support Mental Health – trauma-focused therapy as well as sleep health interventions, like CBT-I, can help turn things around before it is too late.
  4. Narcan Training – once possible exposure has been determined, learn where to get and how to use Narcan; the life you save could be yours.
  5. Anonymous Drug Screening – like any good escape route or evacuation plan, know where the local places for safe and anonymous fentanyl screening are in your area and keep a map nearby.

Share The Dream of a Fentanyl-Free World

Fentanyl poisoning, abuse and overdose are only half the story – it creeps into our sleep and increases suicide risk just by being near us. By understanding how it all connects, you can educate yourself and protect others.

Maybe someone you know is struggling with pain and needs opiate-based medication; maybe you have a loved one struggling with changes in sleep and mood. Either is a breeding ground for fentanyl risk. Even more so, if someone you know is struggling with self-injurious behavior, especially consuming too many pills, but claims no desire to become suicidal, these pills have the potential to be laced with fentanyl, and the result might be suicide unintentionally.

Share these early warning signs, because it may be the difference between waking up, or being stuck in a nightmare. Together, we can make a shared dream state where fentanyl no longer creeps up on us.

‍‍**Please note: This post is for educational purposes only. This post does not constitute medical advice and is not intended as a substitute for professional medical advice, diagnosis, or treatment, and readers are advised to consult with a qualified healthcare professional for any medical concerns or conditions. The views expressed may not reflect those of all healthcare professionals



References

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