Traditionally, clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. This research has clinical application, because treating a sleep disorder may also help alleviate symptoms of a co-occurring mental health problem.
The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night’s sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability.
Sleep in Relation to Bipolar Disorder
According to a Harvard Health Publication, studies in different populations report that 69% to 99% of patients experience insomnia or report less need for sleep during a manic episode of bipolar disorder. In bipolar depression, however, studies report that 23% to 78% of patients sleep excessively (hypersomnia), while others may experience insomnia or restless sleep.
Longitudinal studies suggest that insomnia and other sleep problems worsen before an episode of mania or bipolar depression, and lack of sleep can trigger mania. Sleep problems also adversely affect mood and contribute to relapse.
Bipolar is a circadian rhythm disorder. This means that the internal body clock – the thing that regulates sleep wake cycles, among other things – doesn’t work properly.
According to the 2014 review, Circadian rhythms and sleep in bipolar disorder: implications for pathophysiology and treatment, patients with bipolar disorder show altered rhythmicity in body temperature and melatonin rhythms, high day-to-day variability in activity and sleep timing, persistent disturbances of sleep or wake cycles, including disturbances of sleep continuity.
There are several ways a person with bipolar disorder can attempt to get regular sleep without resorting to more medication. These methods are known as sleep hygiene. Sleep hygiene is a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness.
One of the most important sleep hygiene practices is to spend an appropriate amount of time asleep in bed, not too little or too excessive. Sleep needs vary across ages and are especially impacted by lifestyle and health. However, there are recommendations that can provide guidance on how much sleep you need generally. Here is a list of other good sleep hygiene practices.
Additional Sleep Hygiene Tips
- Try for 8-9 hours a night.
- Turn off cell phone ringer.
- Read rather than watch TV to fall asleep.
- Sleep with white or background noise.
- Maintain consistent daily routine and sleep schedules.
- Get the temperature right.
- Take seasonal precautions, when necessary.
- Keep pets out of your bed.
Use of Sleep Aids
Researchers have not done much testing of sleep aids in patients with bipolar disorder. The agents most often prescribed for insomnia in bipolar patients are the newer benzodiazepine-like drugs, such as eszopiclone, zaleplon (Sonata), and zolpidem. Two anticonvulsants, gabapentin (Neurontin) and tiagabine (Gabitril), might also treat insomnia in patients with bipolar disorder.
If sleep aids are necessary, there are risks involved:
- They can be very addictive. Careful management is important.
- They can have an adverse affect on coordination and cause sleepiness and amnesia.
- In some cases, these drugs can also cause hostile and aggressive behavior.
- They should not be combined with alcohol or other substances that inhibit the central nervous system.
- Tricyclic antidepressants, though often prescribed to alleviate sleep problems because they are sedating, can trigger mania in patients with bipolar disorder.
- Likewise, antipsychotics may worsen sleep-related movement disorders in this population.
WebMD stated that for three out of four people with bipolar disorder sleep problems were the most common signal a period of mania was about to occur.
Dr. Ellen Frank PhD is the author of Interpersonal Psychotherapy, a distinguished Professor of Psychiatry and Professor of Psychology at the University of Pittsburgh School of Medicine, Western Psychiatric Institute and a member of the Pittsburgh Mind-Body Center. Here is an article in which Dr. Frank is interviewed and discusses the importance of sleep in maintaining mental wellness.
Arianna Huffington’s Sleep Revolution
This article published in Psychology Today, discusses Arianna Huffington’s advocacy promoting sleep as a priority for the public health agenda in the U.S., as well as her new book entitled “The sleep revolution: Transforming your life one night at a time” (NY: Harmony Books 2016).