The Role of Sleep in Bipolar Disorder

By

Linda Wasmer-Andrews

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The up-and-down moods of bipolar disorder are often accompanied by erratic sleep habits. Improving one helps the other. By taking medication for bipolar disorder, you may be able to sleep better. And by following a healthy sleep routine, you may be able to manage bipolar disorder more effectively.

Extreme Moods, Troubled Sleep

A bad night’s sleep can make anyone cranky. When you have bipolar disorder, however, the relationship between your sleep and your moods is much more complex and intense.

Bipolar disorder is characterized by two extreme moods: mania or hypomania (an extremely excitable mood) and depression (an extremely low mood). Episodes of mania and depression are usually punctuated by periods of calm. Along with these dramatic shifts in your mood, you may have troublesome changes in your sleep.

Here’s the typical sleep pattern someone with bipolar disorder experiences:

  • Before a manic episode. It’s common to start sleeping less in the days leading up to a manic episode. At times, this may simply be the earliest symptom of an episode that’s already developing. At other times, however, lack of sleep may be the trigger that sets mania in motion. Studies have shown that sleep deprivation can set off bipolar symptoms in some vulnerable individuals. More research is needed to sort out this complicated relationship.

  • During mania. In the grips of a manic episode, you may sleep very little, yet feel as if you’re not tired. When you do drop off, research shows that mania is often accompanied by abnormal REM sleep—the phase of sleep in which dreaming usually occurs. Scientists are still learning about the functions of REM sleep. However, it’s known that REM sleep activates parts of the brain involved in learning and memory.

  • During depression. Sleep problems are also common when you’re feeling depressed. Some people sleep way too much. Others battle insomnia, having trouble falling or staying asleep. REM sleep is often disturbed during depression, too.

  • Between episodes. Even during symptom-free periods, your sleep may be different from that of someone without bipolar disorder. You may still have milder problems with sleeping too much or too little.

Good Sleep Habits = Better Mental Health

What’s behind the link between bipolar disorder and sleep? Growing evidence points to a malfunction in the circadian system—a group of body rhythms that follow a 24-hour cycle.

Among other things, these body rhythms tell your brain when it’s time to fall asleep and wake up. Sleep rhythms and moods are controlled by some of the same areas of the brain. They’re also affected by some of the same brain chemicals, including dopamine and serotonin.

Your sleep rhythms respond to natural cues, such as sunlight. But they’re also affected by social cues, such as your daily schedule for waking up, working, eating, and going to bed. That’s why doctors recommend sticking with a consistent bedtime and wake-up time, even on weekends, to get a better night’s sleep.

When you have bipolar disorder, there may be added benefits to following a steady sleep routine. Research suggests that this may keep your moods on a more even keel. It might even prevent or shorten some bipolar episodes.

Building a Better Sleep Routine

One treatment that harnesses the power of a good night’s sleep is social rhythm therapy (SRT). In SRT, you learn to make positive changes in your daily routine and sleep schedule.

Let’s say that, looking back on a recent manic episode, you realize that you were up late with your friends for three nights in row just before it started. Working with your therapist, you might decide to go home by 11 p.m. in the future. To help you stick to your guns, you could ask a friend for support. If you were drinking too much while out, you could also talk with your doctor or therapist about getting your alcohol use under control.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 3, 2015

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Medical References

  1. Circadian Rhythms and Sleep in Bipolar Disorder. Murray, G. and Harvey, A. Bipolar Disorders. 2010; 12:459-72.;
  2. Implementing Interpersonal and Social Rhythm Therapy for Mood Disorders Across a Continuum of Care. Swartz, H.A., et al. Psychiatric Services. 2011;62:1377-80.;
  3. Interpersonal and Social Rhythm Group Therapy for Patients with Bipolar Disorder. Bouwkamp, C.G., et al. International Journal of Group Psychotherapy. 2013;63:97-115.;
  4. Sleep Disturbance in Mental Health Problems and Neurodegenerative Disease. Anderson, K.N. and Bradley, A.J. Nature and Science of Sleep. 2013;5:61-75.;
  5. Your Guide to Healthy Sleep. National Heart, Lung and Blood Institute. August 2011. (http://www.nhlbi.nih.gov/health/public/sleep/healthy_sleep.pdf);
  6. Circadian Rhythms Fact Sheet. National Institute of General Medical Science. June 12, 2013. (http://www.nigms.nih.gov/Education/Factsheet_CircadianRhythms.htm);
  7. Bipolar Disorder. National Institute of Mental Health, undated. (http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml);
  8. Bipolar Disorder. American Psychiatric Association, undated. (http://www.psychiatry.org/bipolar-disorder);

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