Bipolar Disorder and Sleep

Article by Ronald R. Fieve, M.D.

ExcerptThe following is an excerpt from the book Bipolar IIby Ronald R. Fieve, M.D.Published by Rodale October 2006.95US/.95CAN 1-59486-224-9Copyright © 2006 Ronald R. Fieve, M.D.

Bipolar Disorder and Sleep

“How numerous hours do you sleep on average at night, and what is the quality of your sleep?” are two of the very first questions I ask every patient on the initial interview and all subsequent follow-up visits. Even though the hypomanic usually gloats over how little sleep he requirements, getting by on 3 to four hours a night, the lack of high quality sleep can wreak havoc on his mood and decision-making abilities. Sleep deprivation results in feelings of malaise, poor concentration, and moodiness, and even accidental deaths.

In a revealing sleep study published in the September 2005 issue of the Journal of the American Medical Association, Judith Owens, MD, and her team of researchers from Hasbro Children’s Hospital in Providence, Rhode Island, followed 34 pediatric residents from Brown University over the course of 2 years to compare post-call performance to performance right after drinking alcohol. Throughout this time, the residents were tested under light call (1 month of daytime duty with no overnight shift, or about 44 hours of work per week) and heavy call (overnight duty each fourth night with an average of 90 hours of work a week). The residents performed laptop or computer tasks to gauge their attention and judgment right after their light call (soon after consuming alcohol) and heavy call shifts (with placebo). The residents who had been on heavy call and had not ingested alcohol performed worse on the computer tests than those doctors who had taken alcohol and were on light call. Dr. Owens concluded that the residents had been so sleep-deprived that they didn’t recognize that their own judgment was impaired.

Drugs, stressful situations, and even excessive noise can affect daily body rhythms and moods. Once a Bipolar II mood disorder with disturbed rhythms has begun, it tends to be self-perpetuating, since depression and anxiety are likely to disrupt 24-hour rhythms further. An irregular living schedule can aggravate mood disorders. The old-fashioned sanitarium rest cure was successful with the “nervous” because it put the patient on a typical schedule of sleep, activity, and meals.

Insomnia

How is your sleep? Do you have difficulty falling asleep? Or do you toss and turn most of the night until you fall into a deep sleep just hours prior to the alarm goes off? A person suffering from insomnia has difficulty initiating or maintaining regular sleep, which can result in non-restorative sleep and impairment of daytime functioning. Insomnia includes sleeping too small, difficulty falling asleep, awakening often throughout the night, or waking up early and being unable to get back to sleep. It is characteristic of many mental and physical disorders. Those with depression, for example, may experience overwhelming feelings of sadness, hopelessness, worthlessness, or guilt, all of which can interrupt sleep. Hypomanics, on the other hand, can be so aroused that finding top quality sleep is virtually impossible without medication. In a study at the University of Oxford in the United Kingdom, Allison G. Harvey, PhD, and colleagues in the department of experimental psychology determined that even between acute episodes of bipolar disorder, sleep issues were still documented in 70 percent of those who were experiencing a typical (euthymic) mood at the time. These regular-mood patients with bipolar disorder expressed dysfunctional beliefs and behaviors regarding sleep that were similar to those suffering from insomnia, such as high levels of anxiety, fear about poor sleep, low daytime activity level, and a tendency to misperceive sleep. Dr. Harvey concluded that even when the bipolar patients were not in a depressive, hypomanic, or manic mood state, they still had difficulty maintaining good sleep.

Delayed Sleep Phase Syndrome

This is the most common circadian-rhythm sleep disorder that results in insomnia and daytime sleepiness, or somnolence. A short circuit between a person’s biological clock and the 24-hour day causes this sleep disorder. It is generally discovered in those with mild or key depression. In addition, certain medications used to treat bipolar disorder may disrupt the sleep-wake cycle. I typically suggest chronotherapy to patients. This therapy — an attempt to move bedtime and rising time later and later every day until both times reach the desired objective — is typically utilized to adjust delayed sleep phase syndrome. To adjust the delayed sleep phase issue, sleep specialists may possibly also use bright light therapy or the natural hormone melatonin, particularly in depressed patients.

REM Sleep Abnormalities

REM sleep abnormalities have been implicated by doctors in a variety of psychiatric disorders, which includes depression, posttraumatic stress disorder, some forms of schizophrenia, and other disorders in which psychosis occurs. Special tests, referred to as sleep electroencephalograms, record the electrical activity of the brain and the good quality of sleep. From these tests, we know that in folks who are depressed, NREM sleep is reduced and REM sleep is increased. Most antidepressant medications suppress REM sleep, leading some researchers to believe that REM sleep deprivation relates to an improvement in depressive symptoms. However Wellbutrin XL, a typical antidepressant, and some older medications employed to treat depression do not suppress REM sleep. Researchers are consequently still trying to figure out the connection between the REM sleep mechanism and depression.

Irregular Sleep-Wake Schedule

This sleep disorder is yet an additional difficulty that a lot of with Bipolar II expertise and in large part outcomes from a lack of way of life scheduling. The reverse sleep-wake cycle is typically experienced by bipolar drug abusers and/or alcoholics who remain awake all night searching for comparable addicts and engaging in drug-seeking behavior, which outcomes in sleeping the next day. This sleep disruption and irregularity make it significantly far more tough for the bipolar patient’s physician to treat him or her with conventional medications and adjunctive cognitive therapy. In most circumstances, the patient needs to acknowledge the drug-looking for behavior and get involved in a recovery program such as Alcoholics Anonymous, Cocaine Anonymous, or other group. Talk therapy with a psychologist is beneficial to numerous patients as they seek to alter destructive lifestyle habits and understand new behaviors that will support them adhere to a far more regular sleep-wake schedule.

Reprinted from: Bipolar II: Improve Your Highs, Increase Your Creativity, and Escape the Cycles of Recurrent Depression — The Important Guide to Recognize and Treat the Mood Swings of This Increasingly Typical Disorder by Ronald R. Fieve, M.D. © 2006 Ronald R. Fieve, M.D. Permission granted by Rodale, Inc., Emmaus, PA 18098. Accessible wherever books are sold or directly from the publisher by calling at (800) 848-4735.

About the Author

Ronald R. Fieve, MD, is the author of two widely acclaimed books on mental health, Moodswing and Prozac (translated into five languages). He is professor of clinical psychiatry at Columbia Presbyterian Medical Center and Columbia College of Physicians and Surgeons, Columbia University, and principal investigator, Fieve Clinical Services, Inc. He maintains a private practice in New York City.