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
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.