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What’s the Deal with Sleep and Bipolar Disorder?

In my history with bipolar disorder I have experienced many sleep problems. Typically, I can’t get to sleep at night and require sleep medication nightly to induce sleep. And while, historically, I have slept through the night after this medication, more recently, I’ve had trouble with mid-night awakenings. And I consider bipolar wellness to be highly correlated with sleep duration and quality. So what is the deal with sleep and bipolar anyway?

Bipolar – A Circadian Rhythm Disorder

Bipolar is actually a circadian rhythm disorder. This means that your sleep-wake cycle, and to a lesser extent other biological rhythms (such as hunger), are off-kilter and people with bipolar disorder have a natural tendency to want to stay up particularly late. And, interestingly, one of the reasons that lithium works for bipolar disorder is because it actually addresses a gene abnormality that affects our circadian rhythms. Even during remissions, people with bipolar disorder still experience circadian rhythm disruption.

Sleep Disruption in Bipolar Disorder

Bipolar and sleep tend to trend together; when one works so does the other or there are problems with both. What's the deal with sleep and bipolar anyway?Sleep disruptions are native to bipolar disorder but can also be caused by psychiatric medication. Sleep disruptions in bipolar disorder include:

  • Reduced sleep duration
  • Trouble getting to sleep (sleep latency)
  • Reduced sleep quality
  • Increased sleep disturbances (including nightmares)

These disruptions are correlated to poorer physical health and problems with mood. And, in fact, poorer sleep is correlated to increased risk of suicide attempts and suicidal ideation. Sleep disruptions affecting mood also seem to be present in first-degree relatives of people with bipolar disorder.

Sleep and Bipolar During Remission

Biological studies have shown that people with bipolar experience abnormal melatonin secretion and reactivity to light even when in remission (although sleep disturbances are worse during a mood episode). The ASMT variant may be linked, in part, to some of this circadian rhythm disruption in both remission and in active episodes. Noted in this study are impairments in sleep onset latency, waking after sleep onset and variability of sleep-wake variables.

How to Improve Sleep with Bipolar

Probably the number one thing you can do to improve your sleep with bipolar is to have good sleep hygiene.

  • Create a bedtime routine that you always do before sleep.
  • Only use your bedroom for sleep (and sex).
  • Keep your bedroom at a cool, but comfortable, temperature.
  • Make sure your sleeping environment is silent and pitch black.
  • Always go to sleep at the same time every night and always get up at the same time every morning (no sleeping in or hitting the snooze button). We tend to be very bad at this as a function of the disease but it’s worth enforcing this one, trust me, you’ll see benefits over time.

According to a study, quetiapine (Seroquel) may be more useful than lithium in improving sleep quality (and in treating bipolar depression). And this very recent study showed that a modification of cognitive behavioral therapy (CBT) to treat insomnia improved sleep and functioning and also reduced episode relapse in patients in euthymia (not in a marked bipolar mood episode).

It’s also worth noting that melatonin is available over-the-counter and that light reactivity can be combatted by limiting light (especially blue light, such as from electronics) before bedtime. (Do not take melatonin without discussing it with your doctor.) Blue light blocking glasses are available (handy so you can watch television before bed and yet not be affected by the blue light; really, these can help).

As I said, I consider sleep to be the biggest impactor on mood on a daily basis so quality and quantity of sleep really matters. If you’re suffering with poor sleep, talk to your doctor and use some of the above tips. It really can improve your stability over time.

You can find Natasha Tracy on Facebook or Google+ or @Natasha_Tracy on Twitter or at Bipolar Burble, her blog.

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7 Responses to What’s the Deal with Sleep and Bipolar Disorder?

  1. cindyaka says:

    Hi Natasha! I found that my sleep greatly improved once I was diagnosed with sleep apnea an put on a CPAP machine. It might be worth checking out for some people. I do still need the occasional 1/2 sleeping pill, but it is far and few in between.

  2. Renita says:

    I agree, getting the right amount/type of sleep and having good sleep hygiene is important for most people but especially for people with bipolar disorder. I’ve had a cold the last couple of days and I’m worn out… been sleeping over 12 hours a day. But with bipolar disorder my regular medication also makes me sleep too much. I suffer more from depression than from mania which causes me to wanna sleep more. The quality of my sleep is what’s important to me. I find that the seasons can also affect my circadian rhythms as well as other environmental factors (i.e stressors) and my medication sometimes needs to be adjusted

  3. Pam says:

    yes I take Seroquel…It helps me sleep…now the mania I sleep less and with depression I want to sleep more to stave off the suicidal thoughts….

  4. sARAH says:

    I have to resort to working 2nd shift due to sleep issues. I can’t seem to fall asleep before 2am and can’t seem to function before 10am. It’s a vicious cycle because I get home at midnight and it takes me awhile to unwind. I want to get up in the morning to get some exercise but can’t seem to drag my ass outta bed so right now my weekdays consists of sleep and work. Not a very good combination. I tried to adjust to a first shift schedule and I just can’t seem to do it. I just can’t stay awake during the day. I have to fix this issue soon because i am starting to go crazy. The frigid temp doesn’t make it any easier.

  5. sherry says:

    Melatonin is not available over the counter in Europe. It is 3.30AM as I type!

  6. Elliot says:

    I’ve had to resort to diphenhydramine-almost 200mgs–yes I sleep and have a bit of trouble waking up–but I wouldn’t stop.

  7. FugueState says:

    I primarily see my bipolar as a circadian rhythm disorder and not sleeping is my main trigger to an episode rather than the last ‘pathway’. My main issue is that I don’t stay asleep. However, I have found that the meds that I was on which affected serotonin (quetiapine and sertraline) made me waking up during the night worse. Yes, quetiapine helped me get to sleep but it took a year for me to work my way back up to 7 hours a night and I was waking up 5 or 6 times a night. I seemed to dream a lot, and have very vivid dreams, and given that you normally wake from REM sleep, figured that the excessive dreaming gave more opportunities to wake up. I wouldn’t call it good quality sleep. It got better when I weaned myself of the sertraline but now that I am off both of them I sleep better than I have in over a decade: I wake up once, and I’m not aware of spending so much time dreaming while asleep.

    The quetiapine also led to an increase in cycling for me. I tried to let my doctor know that I would rather have longer periods of a mood episode (even depression) than the unpredictability of mood swings during the day, or across days, even though my doctor considered this to be ‘stability’. I found it intolerable.

    My stance now is that I don’t want to take anything that affects serotonin as it is involved in sleep and migraines (and I have an almost constant headache and nausea when taking these meds, with the sertraline being particularly brutal). I would rather take a typical neuroleptic for a short period of time than an atypical; I’ll never take an SSRI again, and – this one is hard to swallow for me – I would rather take lithium or an anticonvulsant than an atypical.

    But this is just my experience. I have particularly weird sleep and history of migraine, and medical history, which makes me think that certain meds are really not a good idea for me.

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