Purpose of Review <p>Insomnia is a well-established risk factor for suicidal ideation and behavior, yet it remains unclear whether treatments specifically targeting insomnia reduce suicide risk. This systematic review synthesizes randomized controlled trials evaluating the effects of insomnia-specific interventions on suicidal ideation and related outcomes as proxy of suicide risk across clinical contexts and risk strata.</p> Findings <p>Insomnia-specific interventions consistently produced moderate to large improvements in sleep outcomes. Suicidolytic effects, however, were heterogeneous and strongly context dependent. Reductions in suicidal ideation were most consistently observed in individuals with active baseline suicidal ideation and severe insomnia, whereas trials conducted in low-risk populations generally demonstrated null or transient effects despite sustained sleep improvement. Mechanistically, insomnia appears to reflect a dynamic and context dependent mediator of suicide risk, rather than operating as a consistently independent causal driver.</p> Summary <p>Current evidence suggests that insomnia specific treatments function most robustly as a suicidolytic intervention rather than a standalone preventive strategy. Future adequately powered trials should be designed a priori to assess change in suicidal ideation with insomnia specific treatments in high-risk populations and explore neurobiological/mechanistic pathways linking sleep improvement to suicide risk reduction.</p>