How Sleep and Bipolar Disorder Interact

What do you need to know about sleep and sleep patterns when you have bipolar disorder? If you've found that your sleep patterns are abnormal, for example, if you either sleep 12 to 14 hours at a time or stay up all night, you may find that changing the way you sleep can substantially improve your condition. Studies tell us that sleep issues can have a profound impact on those with bipolar disorder or even those at risk for bipolar disorder.

Before talking about how sleep habits affect bipolar disorder, however, let's look at this from the other side. How does bipolar disorder affect sleep?

Bipolar Disorder, Depression, and Sleep Problems

Sleep disturbances are very common in people with bipolar disorder and appear to play an important role in the cycling of the disorder.

• Insomnia: Insomnia includes not only difficulty in falling asleep, but difficulties staying asleep or getting too little sleep. Insomnia is common with many physical and mental health conditions. In those with bipolar disorder, hypomania and mania can often lead to insomnia. When this occurs, treatment of the underlying condition (hypomania or mania due to bipolar disorder) is a goal of treatment.
• Delayed sleep phase syndrome: Delayed sleep phase syndrome is a circadian rhythm disturbance. It can be associated with depression and other mental health issues, but is most prominent in adolescents.
• Irregular sleep: wake schedule - When people with bipolar disorder have a lack of a sleep routine, the irregular cycle can greatly interfere with appropriate treatment of the disorder. Treatment focuses on treating the cause which keeps them up at night.
• Nightmares: Vivid dreams, nightmares, and night terrors may also affect people with bipolar disorder. As with insomnia, the goal of treatment is to best treat the underlying bipolar disorder.

It's clear that bipolar disorder can lead to sleep disorders, but what about the opposite scenario? Can sleep problems lead to or precipitate bipolar disorder in those at risk for the condition?

Sleep as a Precipitant of Mania with Bipolar Disorder

What may surprise you is that reduced sleep isn't just a symptom of mania—a short night can actually precipitate manic and hypomanic episodes.

Studies have found that 25 to 65 percent of people with bipolar disorder who had a manic episode had experienced a social rhythm disruption prior to the episode. "Social rhythm disruption" is some disturbance in routine affecting the sleep/wake cycle; it can be as simple as staying up extra late to watch a movie on television or getting wrapped up in an interesting online chat session, or as serious as being unable to sleep due to a family member's serious illness or death.

"For reasons we have yet to learn, people with bipolar disorder seem to have more delicate internal clock mechanisms," said Dr. Ellen Frank, who has extensively studied these issues.

Could Sleep Disorders Actually Lead to Bipolar Disorder?

Some scientists speculate that one reason the incidence of bipolar disorder has risen in modern times is the development of bright artificial light. Once upon a time, most people's sleep/wake cycles were regulated by the sun. The artificial light changed all that and made it more likely that people who have a genetic predisposition toward bipolar disorder would actually develop the condition.

While a causal relationship hasn't been proven, sleep disturbances in people with bipolar disorder have also been linked with changes in the microstructure of the white matter of the brain.

How to Cope

Just as sleep disturbances due to bipolar disorder need to be addressed, those sleep disturbances which could worsen bipolar disorder need to be addressed as well.

If you're suffering from insomnia, good sleep hygiene is critical. Experts recommend that you:

• Go to bed and get up at the same time every day
• Avoid naps, especially naps in the late afternoon. If you must nap, try to limit your rest to around one hour.
• Use your bedroom for sleep and sex only.
• Avoid heavy meals a few hours before retiring.
• If you can't sleep after a certain amount of time (for example, 15 minutes) get out of bed and do something. It' still important to get up at your regular time the next morning, even if you will have less than seven hours of sleep.

If you are coping with hypersomnia (sleeping too much) it's often advised that you gradually reduce the amount of time you spend sleeping by using an alarm clock.

Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may be of particular help for treatment-resistant rapid cycling bipolar disorder. Such therapy may begin by enforcing complete light and sound deprivation for as many as 14 hours per night, which can be gradually reduced once a person's moods are seen to stabilize.

Psychotherapy and medications can also play an important role in improving sleep habits, and in doing so, bipolar disorder symptoms as well.

Involving Your Family in Your Sleep Habits

Doctors point out the need to involve a person's family in the effort to regularize the sleep/wake cycle. Family members should be taught about the vulnerability to changes in daily routine experienced by people with bipolar disorder. This awareness is critical as a partner's well-intentioned, "I know the party will last all night but can't we do it just this once?" could nudge a person with bipolar disorder straight into a manic episode. It can also help for family members to learn the signs of an episode's onset, whether manic, hypomanic, or depressive and be prepared to intervene before the mood swing becomes full-blown.

Bottom Line

If you or a loved one suffer from any type of mood disorder, pay attention to the sleep/wake patterns of the person involved. If you identify insomnia, hypersomnia, poor-quality sleep and/or reduced need for sleep, this should be brought to your/your loved one's doctor's attention right away. Treating the sleep disorder is likely to significantly help the mood disorder as well.