The Importance of Sleep in Bipolar Disorder
If there’s one thing that affects my bipolar moods above all else it is sleep. I consider getting the right amount of sleep to be critical in maintaining or achieving wellness. It’s also critical that this sleep happen at exactly the same time every night.
In short, being a control freak about sleep is a good thing.
Bipolar is a Circadian Rhythm Disorder
I’ve said it before and I’ll say it again: bipolar is a circadian rhythm disorder. This means that your internal body clock – the thing that regulates sleep wake cycles, among other things – doesn’t work properly. In fact, 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.
And they follow up with:
The internal clocks are, indeed, responsible for regulating a variety of physiologic functions, including appetitive behaviors, cognitive functions and metabolism . . . An underlying circadian pathology in bipolar disorder is a unifying explicatory model for the high psychiatric and medical comorbidity observed during the long-term course of the disorder.
In other words, if your sleep is off, your physical functions are also off.
What Happens to My Bipolar When My Sleep is Altered
I can say that as the researchers note above, my sleep continuity is almost always disrupted and I suspect it’s by the bipolar disorder. It’s extremely rare that I wake up in the morning without remembering moments of wakefulness during the night. The more wakeful moments I remember, the worse my day generally is.
Similarly, if I can’t get to sleep at night or if I wake up early, it’s another red flag that something is wrong and it usually means that I’m heading towards a very bad day.
And when I say “worse” and “bad day” I mean a day where I’m overreactive and overemotional. I mean a day when I will feel depressed and be less productive (if productive at all). I mean a day when I function much less on a very, basic level.
Missing sleep or disrupted sleep isn’t about being tired (although, like everyone else, I feel that too) it’s about an alteration to mood and functioning. And when I say that, I don’t mean it in scientific gobbledigook – I mean it in real life terms that result in tears over slight notions and an inability to do anything but lie on my couch in the fetal position.
Treating Sleep-Wake Problems in Bipolar Disorder
I think it’s important to remember that “natural sleep” (sleep that is not drug induced) is, in my opinion, always superior to sleep that is controlled by medication. That being said, for many of us, we need sleep medication to have anything even resembling a natural sleep-wake cycle.
In my case I use a nonbenzodiazepine sleep medication. Some doctors don’t like these and some even won’t prescribe them but, personally, I have been using one for ten years without issue. (Note: if substance abuse is in your background, these are not for you.) It absolutely ensures that I get to sleep at the same time every night and that makes it worth double its weight in gold to me. (One should note that sleep medications rarely help people who wake early or help with disrupted sleep, particularly later in the night.)
It also appears that quetiapine (Seroquel) is helpful in improving sleep quality in patients with bipolar depression improving both sleep and depressive symptoms (although how those two are related is not known). (Doctors often prescribe quetiapine and other second-generation antipsychotics for sleep problems.)
Psychoeducation has been shown to likely not be useful in sleep regulation (long term use being possibly useful).
What is useful in treating sleep problems in bipolar disorder is social rhythm therapy. Or, more specifically, being very regimented about when activities in the day occur and adopting good sleep hygiene. Sleep hygiene requires it’s own article, but the backbone is always going to bed at the same time and waking up at the same time every day – no matter what. That superimposed regulation can help the body regulate itself. Being this regimented sucks, but it really does work to have a bipolar routine.
Defeating Sleep Problems in Bipolar
In my case, I can tell you I cannot, entirely, defeat the sleep problems in bipolar disorder. Bipolar routines and medication have made my sleep much better and have created a more reliable stability in my life. Nevertheless I do have bad nights resulting in bad days. The important thing to remember is that they, too, shall pass and that a good night’s sleep is still ahead of you.
You can find Natasha Tracy on Facebook or Google+ or @Natasha_Tracy on Twitter or at Bipolar Burble, her blog.
Tracy, N. (2014, September 24). The Importance of Sleep in Bipolar Disorder, HealthyPlace. Retrieved on 2023, March 24 from https://www.healthyplace.com/blogs/breakingbipolar/2014/09/the-importance-of-sleep-in-bipolar-disorder
Author: Natasha Tracy
I have bipolar 1 having been diagnosed aboy 25 years ago. Its been a good three years and i take lamictal abilify and vyvanse. I am at work right now ans feel really overwhelmed I didnt want to come to work today. I feel if anything goes wrong if someone forgets to do something somehow it ends up being my fault. I just wish I coukd go home now and be with my doggies.
Im not sure how I got on this rant since I anly wrote to ask what is cbd.
I have a diagnosis of Bipolar I and without meds I don't sleep. I linger on the edge of consciousness drifting in and out of dreams but still aware of my surroundings pulled back into a hyper alert state when ever there is a noise or I get a sensation of falling (which is frequent through the night). I haven't found anything other than anti-psychotics and strict sleep hygiene that works. Unfortunately I can't seem to find a balance. I either sleep 12-16 hours a day or not at all. I'd rather sleep too much than to little (hallucinations suck) but it does make holding down a job and living in the real world difficult.
Try CBD. It won’t interact with your meds. It is also a great anti-psychotic and anti-anxiety.
Hi Jill and Heather,
CBD may or may not be a good option. Always check with a doctor before trying any drug. Some people find CBD to be anti-anxiety and anti-psychotic, but not all find it this way. There are dangers too. Some people do not react well. Make sure you are under a doctor's supervision any time you try something new.
- Natasha Tracy
Lisa H. Good for you getting your PhD. In your message it appears you feel that gives you some sort of superiority. Personally, my experience with psychologist and psychiatrist have been hit or miss. So to me, your PhD gives you a title and well, that is about it. While there are some wonderful psychiatrist/psychologist out there, there are some terrible ones as well. Which category are you in? Time will tell.
Natasha creates a wonderful community for people to share. She does a great job making it relatable vs some textbook understanding. Unless you live it, it has to be really hard to understand it. Before Lithium, I use to either have energy or angst running through my body most of the time and it was like this feeling from the inside out. Lithium has been truly wonderful for me. So to bring it back to the sleep discussion. Lithium has had a positive impact on my overall mood which helps with sleep. I take 5mg of Melatonin a night and luckily this drifts me off to sleep. There are nights my sleep is disturbed (aka dog has to go out, im sick, on vacation, different time zone, etc) and it's true the next day sucks. It's like I can't wait until the day is over. Sometimes it impacts my mood for much longer. I agree a regiment routine is best for me. I appreciate this article as it shows I'm not alone. Reading it makes me feel less guilty or bad if all I can do one day is lay on the sofa, watch tv and look forward to the day's end. Sounds miserable, it is, yet I like knowing I'm not the only one that feels this way.
I wasn't suggesting that bipolar disorder is only a sleep disorder. I was trying to suggest that sleep disorders can cause psychiatric disorders. Since quacks don't usually check for proper sleep or hydration, we will never know the extent of this link. Anyways I don't care about Natasha's qualifications she has a sexy name and I want to see her naked. As a guy, I think that totally relates to what I was saying.
i ask NATASHA TRACY for advice in Depression and Bipolar cause it that time I was in need of advice in handling both areas of my illness and miss NATASHA TRACY didn't offer any advise but belittled me to hurt my feelings making my Deprression even worst!
If writing story's bout Bipolar n Depression is her job that's fine but she offered me No Help or advice yet she writes about it in a form as if she knew have to help yet not to me. I suffer from both bipolar n depression and seen miss Tracy's story and foolishly thought I could ask advice
Thank you John Smith
Thanks, Natasha. This was a very timely post for me. I've been grappling again with messed up sleep cycles for over a month (despite the fact that I use a CPAP, Steve...and no, my pressure does not need adjusting.) I've been keeping a sleep/mood log to share with my psychiatrist in hopes we can find a way to get more consistent sleep. I've been using an OTC sleep aid that helps me fall asleep...most of the time. But I can't seem to stay asleep for more than 4 hours at a time. Very frustrating...and hell on my mood and activity levels. Hoping for improvement with some med adjustments and maybe something for sleep. Feeling very frustrated right now, but at times I feel resigned that this is just what my life's going to be like. Sucks!
Thanks again for your insight!
This is one of the hardest issues for me. Sometimes it will abate for years sometimes it's much worse because of comorbid stuff like the painful cyst I have at the moment.
I can't sleep now but MH meds will make me almost comotose by morning.
Without the net and my cat I would not cope lol.
My partner works night shift as well so it feels like a double whammie.
I do not agree that bipolar is JUST a sleep disorder though interesting theroy though. Whatever the research says if it was melatonin would be the curr. I don't think we will ever find the one cause simple cause if bipolar so a cure is unlikely. That said I need nine hours sleep per night and on my current meds can jiyfly sleep to midday, I also think part of MY problem is I don't sleep deeply enough and have bat poo weird dreams too.
I also believe Natasha has a QBE in mental health (qualified by experience) I resent people questioning her athority to give advice based on her own life. I think I have a deeper understanding of bipolar then any 'professional' who has not experienced it.
What are your qualifications for giving people advice for managing bipolar? What experience do you have in the field of mood disorders have you had, besides being diagnosed with bipolar? I ask this because I am currently going to school for a PhD in mood disorders, specificly bipolar. I am a licensed addiction counselor who is also living with bipolar. Some of the advice you are giving is great and giving your personal story helps a lot of people. But, some of this advice and things you are presenting as facts are utterly and completely wrong. So please, for my sake as a counselor and a soon to be practicing psychologist stop posting false information that may hurt the individuals you are trying to help.
I am a bipolar expert through almost a decade and a half of research. You are welcome to address anything you feel is inaccurate but note that when I discuss specific facts, I generally link to the sources so you should check those.
- Natasha Tracy
Great article. I have bipolar and sleep really affects me. I am curious what medication you use for sleep? I take seroquel but would be interested in taking another one that is not a benzo. You mentioned it had worked for you for many years.
It would be good to not have to use meds for sleep but not sleeping is worse for my bipolar.
12 years after sleep apnea testing, which I do not have, I was finally diagnosed as bipolar 1.
If I do not have 8 uninterrupted hours of sleep, I am a witch... And not the good kind!
During long or deeper periods of depression, I, like Natasha, find myself plastered to my sofa if my sleep is disrupted or if I get too little sleep. It is as though if I don't get 8 hours, my body will refuse to cooperate until it has gotten it's time in.
This seems cart before horsish. Psychiatrists never ask about proper water intake & they never send patients for sleep apnea testing. Sleep apnea, or sleep deprivation can cause depression, bipolar disorder and dehydration doesn't help it either. No wonder quacks say that it can't be cured, they avoid looking at the obvious. No consideration to diet, exercise, hydration or sleep. I was diagnosed as bipolar, suffered diarrhea on lithium for 13 years, then discovered my 131 apnea/hour sleep deprivation. I am now off meds. Asymptomatic. My poles are in order. Too bad for the rest of psychiatrists victims.
I strongly agree with the importance of getting a good night's sleep. I try to get this through to my husband. He is a cancer survivor and no matter how I express to him there importance of a good night's rest, he doesn't get enough sleep. And he doesn't understand how vital it is for me as well for the bipolar disorder. Thanks for the great article.