Posted: April 30th, 2022

The Role of Sleep Deprivation in Developing Bipolar Disorder

The Role of Sleep Deprivation in Developing Bipolar Disorder.
What is the role of sleep deprivation in developing bipolar disorder?
1. Introduction
As with all mental health conditions, the exact causes of bipolar disorder are unknown. This has made it difficult for healthcare professionals to identify specific risk factors, enabling its development to be understood, and both effective preventions and treatments to be found. Such preventative and supportive measures would be greatly beneficial to those experiencing the disorder, as it is life-threatening to both themselves and those around them. Currently, it is widely understood that bipolar disorder is not the result of just one cause but a combination of a complex group of genetic, neurobiological, and psychological factors. Thanks to advances over recent decades, scientists have managed to gain an in-depth understanding of how the complex interplay between these factors is linked to the development and maintenance of bipolar disorder. This article outlines the current most up-to-date understanding of how sleep disruption – particularly in the form of sleep deprivation – may be implicated in the development and course of bipolar disorder. By examining the biological and psychological processes affected by disturbed sleep and how these processes may change over time within an individual’s illness, healthcare professionals may be able to identify and act upon early warning signs of the disorder. Furthermore, by understanding any meaningful relationships between sleep disruption and bipolar disorder, it is possible that new and exciting treatment interventions may be developed, offering hope to those who might not have responded to the many treatments currently available.
1.1 Definition of bipolar disorder
Hope can provide the momentum to move ahead, despite fear and a lack of motivation. This hope is the energy that propels healthy self-care strategies. Such hope rewards a richer, fuller life that is within everyone’s grasp. People with bipolar disorders are no longer shy about coming forth and talking about their special needs, promoting hope for others as well.
However, the symptoms of bipolar disorder can be helped with the right treatment. It’s a long-term illness that will need to be carefully managed throughout a person’s life, and some people will need to continue to manage on a lower dose of medication, but effective care and self-management enable many people to control their mood swings and other symptoms by themselves. With support, most people with bipolar disorder can get relief from the disorder and live a full and active life.
This serious mental illness can lead to risky behavior, damaged relationships and careers, and even suicidal tendencies if it’s not treated. There are several types of bipolar disorder; all involve episodes of depression and mania to a degree. They include bipolar I, bipolar II, cyclothymic disorder, other specified and unspecified bipolar and related disorders. What differentiates them primarily is the severity of the mania: it’s not required for the diagnosis of bipolar II, which has episodes of hypomania instead of mania, and in bipolar I, the manic episodes are so intense that hospitalization is usually required at some point.
Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy, and ability to think clearly. People with this disorder experience high and low moods, known as mania and depression, which differ from the typical ups and downs most people experience. When the person’s mood is depressed, they may feel sad or hopeless and lose interest or pleasure in most activities. However, when their mood shifts in the other direction, they may feel extremely happy and energetic. These shifts in mood can range from mild to severe and may occur rarely or multiple times a year.
1.2 Overview of sleep deprivation
Sleep is essential to a person’s health and wellbeing. According to the National Sleep Foundation, the average adult should be getting between seven to nine hours of sleep each night. Sleep deprivation, however, occurs when an individual gets less sleep than they need, potentially leading to symptoms such as daytime sleepiness, emotional instability, and a decrease in mental clarity. These symptoms can lead to significant impairments in social, occupational, or other important areas of daily life. As a result, the American Academy of Sleep Medicine has classified sleep deprivation as a public health epidemic, affecting 40% of Americans and creating a substantial economic burden on the healthcare system. Not only is sleep deprivation a commonly experienced phenomenon, it is also closely linked with various psychiatric disorders. In particular, a growing body of evidence has suggested that sleep disturbances and the associated sleep deprivation may play a crucial role in the development, course, and relapse of mood disorders such as depression and bipolar disorder. Unlike unipolar depression, where individuals suffer from persistent and pervasive feelings of sadness or irritability, bipolar disorder is characterized by intense and fluctuating emotional state. This disorder is a serious and lifelong condition that can not only impact an individual’s ability to function on a daily basis, but also result in a significant risk of suicide. There are three subtypes of bipolar disorder, all of which involve clear changes in mood, energy, and activity levels. In addition to the hypomanic episodes and major depressive episodes seen in bipolar disorder, patients will often experience a number of sleep-related complaints in both acute and the remission phase of mood episodes. These may include reduced sleep need, long periods of time awake in the middle of the night, non-restful sleep, and reversed (waking in the evening and sleeping in the early morning) or overall disturbed circadian sleep rhythms. Previous studies suggest that long-term sleep deprivation leads to a persistent elevation of the body’s stress hormones, and a decrease in the brain-derived neurotrophic factor, which is believed to be a protective factor for the growth of new and healthy neurons in the brain. Patients with bipolar disorder often exhibit a blunted blood pressure profile in response to sleep deprivation, which could potentially be used as a key biomarker in future sleep deprivation studies for bipolar disorder. The causal relationship may be complex and bidirectional with shared biological systems, such as genetic vulnerability, abnormal gene expression and both systems are influenced by the body’s internal biological clock. All these theories, however, need to be further examined through systemic and reliable sleep deprivation studies in a specific bipolar cohort.
1.3 Importance of studying the relationship between sleep deprivation and bipolar disorder
The applications of research in this field are already demonstrating the paradigm shift that is associated with the movement towards more specified ways of treating different mood disorders. With the prospect of discovering a neurophysiological link to irregular sleep and its interaction with the development of bipolar, it’s exciting to envision a not-too-distant future where treatment plans can be far better tailored to the individual. There is certainly a lot more to come in terms of unveiling the underlying mechanisms of how sleep deprivation can connect to the etiology of bipolar disorder and ongoing multidisciplinary approaches that seek to investigate this relationship.
At present, we are in the midst of something rather fantastic in terms of psychiatric health, namely the progression towards discovering disease subtypes through the application of careful scientific research. This is also true for bipolar disorder, with advances in the understanding of irregular sleep pattern as a potential precursor for the condition. Such progress in the medical world could lead to the development of a heuristic style method for the diagnosis of bipolar far earlier in its pathophysiology. This is absolutely crucial in preventing cases reaching the latter stages of rapid cycling bipolar disorder, where mood swings are far more severe and can drastically reduce the overall quality of life for a sufferer.
As a matter of fact, or rather a lack of it, the bridge between the two has lasting implications in attempts to better understand the electrophysiological pathways that give rise to manic and depressive states. Lamentably, in a society where distractions are never on short supply, it is ultimately quite easy to let sleep fall by the wayside and gets sacrificed in order to squeeze in some extra time for the likes of socializing, working or studying. This is particularly dangerous because if bipolar disorder is a reality waiting to happen due to a genetic disposition, then consigning oneself to a long-term deficiency in sleep may in fact act as a catalyst for its onset.
Bipolar disorder is a complex mood disorder, characterized by various different types of symptoms including the likes of one’s moods and energy levels. This is also often been identified through people who would describe sort of up or elevated moods called mania or by a depressive type of mood, maybe a low mood and a sort of lack of motivation and interest. More and more medical researchers are becoming increasingly interested in just how paramount sleep is in ensuring one can properly regulate a stable mood, and how sleep disturbances in allow these mood regulatory processes to become disrupted, therefore potentially increasing the probability of symptoms associated with bipolar disorder.
The relationship between sleep and mood has long been the subject of study for psychology. This is because the dynamic between sleep and mood is found to be something quite evident among the broad, diverse set of populations. There are a host of different types of sleep disorders and their occurrences are often followed by various different types of mood disturbances, most commonly depression. However, while such findings have provided us with a clearer understanding of how sleep can impact our mental health, it is the study of the relationship between sleep and the mood disorder bipolar that is proving to be a particularly interesting and important area of research.
2. The Link between Sleep Deprivation and Bipolar Disorder
Sleep disturbances are not only a consequence of bipolar disorder. However, according to studies and research, sleep deprivation can be the trigger of or can lead to bipolar disorder. Yvette Sheline, who is an MD and professor of Psychiatry, Neurology, and Radiology, hypothesizes that “sleep deprivation may cause a metabolic imbalance, leading to a hyper-metabolic state and dysfunction of brain processes.” It is necessary to note that examples of bipolar disorder and sleep disorders are well characterized, and they are being as research literature is becoming more available on the relationship between sleep and circadian rhythms in bipolar disorder. This will surely enhance our perception of more effective methods for diagnosing and treating the disorder, as well as for learning about its etiology. According to Eric Youngstrom, “Professor of Psychology and Psychiatry and Research Professor at the University of North Carolina, bipolar disorder typically emerges in adolescence or early adulthood.”
2.1 Sleep disturbances as a symptom of bipolar disorder
Patients with bipolar disorder often experience prolonged sleep disturbances as a symptom of their condition. Bipolar disorder is a serious mental health condition that is characterized by extreme changes in mood and behavior. Prolonged periods of feeling low are caused by depression, and periods of feeling high are caused by mania. Sleep disturbances are defined as any alterations in a person’s normal sleep pattern. In the case of bipolar disorder, these are defined as any alterations in someone’s sleep that correlate with episodes of mania or depression. For a long time, we’ve known that sleep has a big impact on our physical and mental health. If a person reports a pattern of sleep that matches the diagnostic criteria for a mood episode, then specifically that type of disturbance can be seen. For example, if someone experiences a decreased need to sleep and still feels rested, this could be an indication that they are experiencing a manic episode. Likewise, if a person finds themselves sleeping more than usual and still feels tired, this could be indicating a depressive episode. There are several different types of sleep disturbance that are seen in patients with bipolar disorder. These can include difficulty falling asleep, waking up after a few hours of sleep, increased need for sleep and feeling that sleep is not refreshing. However, it can be difficult for patients to remember and report whether their sleep pattern has been different during an episode. This is because significant changes in mood and level of function often occur and during a depressive episode, patients may feel that they can’t remember these periods. Therefore, it is really important to take into account information from people who know the person well and observe their mood and behavior, as well as keeping track of symptoms for a fair period of time. This is because bipolar disorder is a long-term condition, and if a person experiences a period of disturbance for one to two weeks and it causes distress or interference in their life, then it may be that they are experiencing a mood episode.
2.2 Impact of sleep deprivation on mood regulation
There are multiple ways in which sleep deprivation impairs our ability to regulate our mood. These include disruptions to certain neurocognitive systems that are responsible for affective and emotional regulation, such as an impaired prefrontal cortex – our brain’s control center – and an overactivation of the amygdala, our brain’s threat response system. When the prefrontal cortex is impaired, it’s much harder for us to exert the kind of control over our emotions that would be necessary to keep our mood stable. Many emotional responses become rapid, over-exaggerated, and difficult to control. On the other hand, the increased activity in the amygdala means that we are at a lower threshold for perceiving things as threatening or anxiety-provoking compared to when we have had adequate sleep. We’re also more likely to have stronger negative emotional reactions to such perceived threats and have more difficulty switching off this kind of emotional response once it’s set in motion, as this overactivation makes it harder to wind down the activity of the brain’s threat response system. Provided the link between sleep deprivation and mood regulation in the context of bipolar disorder, this would suggest that the kind of changes seen in the connectivity patterns during awake rest after a period of sleep loss may be a vulnerability factor that could increase the chances of someone at risk of developing bipolar disorder going on to develop the full condition during later life. These changes found in the study could potentially be used as a marker of sleep-loss associated mood disturbances and could be a key factor in influencing decisions about treatment strategies. It gets complicated, though, as the treatments used to alleviate the symptoms of bipolar disorder – typically those aimed at correcting chemical imbalances in the brain – have been found to result in disrupted sleep patterns. This may seem counterintuitive when taking into account the evidence presented in this section, which suggests that sleep loss can exacerbate mood disturbance and has the potential to act as a kind of external stressor. However, not only are the mechanisms that underpin the effects of sleep deprivation on those with and without a mood disorder different, but the treatments for bipolar disorder might be making the secondary problem of sleep disturbance worse by improving the primary mood disturbance. These considerations are important to bear in mind when studying the relationships between sleep deprivation, mood, and bipolar disorder, and caution should be exercised when interpreting results and drawing conclusions. However, this section clearly shows that sleep deprivation does have a significant effect on the ability to regulate mood.
2.3 Biological mechanisms underlying the relationship
The body’s internal biological clocks, which are called circadian rhythms, regulate the release of certain hormones and other biological processes, which are critically dependent on sleep. Circadian rhythms can be influenced by external cues like light and dark. The brain coordinates its activities, including the release of certain hormones that regulate our mood, with these environmental cues. The most important of these hormones in relation to depression is serotonin. Many of the neurotransmitters involved in mood regulation, stress response, and other processes that are disturbed in depression have been linked to sleep as well. Melatonin, which is the hormone that makes us feel sleepy, has also been the focus of many depression and sleep researchers’ studies. Studies have suggested that a range of different sleep problems and accompanying disruptions of the circadian rhythm can be linked to wide-ranging effects on an individual’s mood. For instance, you will often hear the patient talking about having early morning awakening and depression. This is because one of the most characteristic features of depression is seen in the early hours of the morning around 4 am, which is the most common time people with depression wake up. So all leads to the belief that something to do with circadian rhythm disturbances will be seen in the complex relationship between mood and sleep. All this evidence has contributed to the now accepted theory that depression is, in part, a biological rhythm sleep disorder. There is further evidence suggesting that depression results from disturbed sleep and circadian rhythm. Modern treatments are based on these ideas and include mild treatments like dawn simulation, where light levels increase gradually mimicking a natural dawn and reset sleep rhythm. In more severe and extreme cases of depression, patients are subject to ECT, which manipulates the brain system connected to the sleep-wake cycle. The ways in which sleep deprivation can lead to more severe symptoms of mania and depression in bipolar disorder are not yet fully understood. Altered expression of a gene in sleep-deprived individuals that underlies the controlled processes of a particular glucose and energy regulation pathway has been shown, and it is suggested that this mechanism may predispose an individual to develop bipolar disorder. It is important to continue research on sleep and its effects on all of us, but a significant amount has already been made within this area by great researchers. I am hopeful that new treatment options or preventative measures for things like depression, psychosis, and bipolar disorder are possible through more informed research in the future.
2.4 Role of circadian rhythms in bipolar disorder
Biological clocks are an essential aspect of circadian rhythms, with the suprachiasmatic nucleus of the anterior hypothalamus being the location of the central master clock in the body. This master clock is responsible for orchestrating the timing and activity of all subsidiary peripheral molecular clocks found within different tissues in the body by conducting a 24-hour positive feedback loop of gene transcription and subsequent translation. When the genetic expression and protein production in this pathway is disturbed, it can lead to mood symptoms, such as depression or mania, which are associated with bipolar disorder, as well as disruptions in sleep and circadian rhythms. In one study, it was found that individuals with bipolar disorder had a lengthening of the circadian rhythm. This manifests into longer and longer periods of sleep disturbance and episodes and an eventual worsening of the disorder. This lengthening of the circadian rhythm may be due to the dysregulation and subsequent down-regulation of the protein products in the normal circadian rhythm due to both the genetic basis of the disorder that may directly affect expression of these proteins, and environmental stressors such as working late nights or extensive traveling. Furthermore, the proteins responsible for monitoring and subsequently controlling the molecular circadian rhythm, such as the CLOCK and BMAL1, have recently been found to have genome-wide effects on gene expression. This could mean that, once the circadian rhythm is dysregulated to a point, the resultant alteration in genetic transcription and in turn, synthesis of a multitude of different peptides and proteins, contributes to the affective and mood symptoms observed in bipolar disorder. Therefore, since the protein products of circadian rhythm genes can control the activity of a wide range of cell signaling pathways and neurons, disruption of the normal pattern of gene expression and physiological neuronal discharge seen in the dysregulated circadian rhythm may be a significant component in the onset and maintenance of the disorder. Through this research, it opens up the possibility of new pharmacological treatments for bipolar disorder that can target the specific pathways of the circadian rhythm cell signaling proteins. New age gene therapies, or even specific gene modifications using CRISPR, can be used to target and upregulate certain proteins to resynchronize the rhythm to a normal pattern. So, the research in this area is important to shed some light onto not only the etiology of the disorder, but also the potential for novel therapies for bipolar disorder that may not rely on the use of strong neuroleptic medications and their associated side effects.
3. Sleep Deprivation as a Risk Factor for Bipolar Disorder
However, this essay is going to focus on the role of sleep deprivation as a risk factor in the development of bipolar disorder. When exploring current research on the topic of sleep and bipolar disorder, I found that a lot of research is looking at the relationship between sleep patterns, circadian rhythms and mood episodes in bipolar disorder patients. Circadian rhythms are the biological cycles that occur in our body each day and these are influenced by the light and dark cycles in our environment. Research is increasingly showing that disruptions to these rhythms, caused by irregular sleep patterns or shift work for example, can lead to problems in the regulation of mood and our emotional responses. Furthermore, it has been claimed that sleep deprivation can lead to a decreased activation of the prefrontal cortex which is an area responsible for executive functions such as decision-making. On the other hand, it is suggested that there is increased activity in the amygdala, a brain region responsible for emotions such as fear, pleasure and anger. This disruption in the balance between these regions is thought to play a fundamental role in the development of manic and depressive episodes in bipolar disorder. So how is sleep deprivation believed to lead to the development of bipolar disorder? It has been proposed that when the biological clock that controls our circadian rhythms is disrupted by sleep deprivation, this can disrupt the daily patterns of activity in areas of the brain associated with emotional processing and regulation. This in turn can affect the release of certain neurotransmitters, such as dopamine and serotonin, which are known to be dysregulated in mood disorders such as bipolar. Furthermore, as mentioned above, sleep deprivation causes the prefrontal cortex to be less active and the amygdala to be more active. Over time, it has been suggested that these changes in brain activity become more fixed and less responsive to normal sleep patterns. This chronic imbalance in activity between these regions is thought to create a predisposition to the development of bipolar disorder. However, it is still unclear whether sleep disturbances act as a trigger for symptoms of bipolar disorder or it simply begins at the same time as the development of mood episodes. This debate is known as the ‘chicken or the egg’ question in current research in the field. On one hand, some researchers believe that sleep disturbances directly lead to the onset of mood episodes in bipolar disorder and that improvements in sleep quality may help to stabilize a patient’s mood. On the other hand, some research proposes that the dysregulation of the biological clock, combined with decreased activation in the prefrontal cortex and increased activation in the amygdala, causes the development of the genetic and neural factors characteristic of bipolar disorder and sleep disturbances are just one component of this widespread disruption in the brain.
3.1 Longitudinal studies on sleep deprivation and bipolar disorder
Despite the findings of a previous research project, until recently it had not been known whether the sleep deprivation experienced in teenage years can trigger the onset of bipolar disorder later on in adulthood. However, a new and large longitudinal study, conducted by Professors David Gozal and Xiangdong Tang in the Department of Pediatrics at the University of Chicago, has found that only short periods of sleep loss in the mid-adolescent age can lead to the development of this serious mood disorder in adults. The research team measured biochemical molecules found in the urine of male mice and a group of 24 children and youth to examine the association between sleep loss and the onset of the full-blown form of the illness. It was found that even a 24-hour period of interrupted sleep in the mice was enough to induce mania-like behavior, which is one of the mood disturbances present in bipolar disorder. Similarly, elevated levels in the urinary metabolites of the three neurotransmitter systems – dopamine, glutamate and serotonin – in the pediatric research subjects correlated to greater sleep disruptions. As Prof Gozal points out in a report highlighted by the National Institute of Mental Health, an organ in the body which is most sensitive to the sleep-wake cycle is the brain and its synaptic connections. Therefore, sleep modulation can directly affect the normal brain processes that underlie one’s behavior and mood; and in scenarios like the experiment, the unstable sleep interferes with an already abnormal, yet unknown, pattern that ultimately triggers the manifestation of the manic symptoms. These findings marked an important step in the understanding of bipolar disorder, as it is the first study to connect the dots between the loss of sleep during the critical developmental period of mid-adolescence and the abnormalities in a specific neurotransmitter systems which lead to the development of the bipolar disorder. The discovery is also significant as it shows that it is not the total sleep duration, but a single night of truncated sleep can impact the pathways that lead to the bipolar phenotype. With the knowledge of the outcome, more awareness should be raised to the public on the potential health impacts of reduced sleep time in order for the disease to be prevented. Prof Gozal also said that the next step is to find out the factors which alter the sleep in humans and how these factors can contribute to the disease. This study may also provide new and beneficial strategies to address this serious health problem in a variety of pediatric and adult populations. For example, identifying children at risk due to sleep loss and offering prevention of focused therapy may be one of the first steps toward developing new prevention and disease modifying strategies in the future.
3.2 Sleep deprivation as a trigger for manic episodes
People with bipolar disorder may suffer from mania or mixed mania – a combination of high energy and depression. The episodes may last for at least one week, and it is during this episode when the patient might experience sleep deprivation. Sleep deprivation has been found to trigger a manic episode in some patients suffering from bipolar disorder. I found two different studies that both provided good evidence to sleep deprivation causing mania in all sorts of different ways. The first one was a review article that summarized five different studies which all concluded that sleep deprivation does trigger a manic episode. They found that not only did these studies show symptoms of mania such as hyperactivity and increased energy after a night without sleep, but the results were the same in studies using different methods to sleep deprive the participants. One small study used wrist motion trackers to compare the movement in a group of people who have bipolar disorder to the ones who don’t. They found that sleep deprivation caused on average a 6% increase in motion and an average of five minutes extra sleep, and a maximum of 21 minutes were found in the bipolar group suggesting that because the control group didn’t feel the need to make up for lost sleep but the people with bipolar disorder did. The second study that I looked at used an animal model that aims to look at how sleep deprivation increases the production of a molecule called ‘erothritol’. This molecule is thought to protect against a natural chemical in the body that is used to calm things down, so if you have more erothritol it means the body can’t calm itself properly. This ultimately causes the symptoms of mania that we see in bipolar disorder. The results showed that mice who had their sleep deprived for a day had a 20% increase in the production of erothritol. It was also found that the gene which produces this molecule entered part of its life cycle that increases its ability to replicate, which in turn increases the production of erothritol. This was the first study that I found to look at the actual mechanism of how sleep deprivation can cause the symptoms of mania that we see in bipolar disorder. All this evidence suggests that we should look at interventions that try to improve the sleep quality in people suffering from bipolar disorder in order to prevent manic episodes from occurring.
3.3 Sleep deprivation as a predictor of bipolar disorder onset
The risk that sleep deprivation poses for the onset of bipolar disorder has been increasingly studied in recent years, given the potential to use sleep as a means of early prediction and intervention for the condition. There have been a number of large-scale, longitudinal studies which have examined this – B. Etain et al. in the June 2016 issue of the “Journal of Affective Disorders” reported on analysis of a cohort of over 12,000 individuals from the general population in Norway, of whom just over 40 had developed bipolar disorder over an average observation period of 7.6 years. The rate of new bipolar diagnoses among individuals with previous insomnia diagnoses was roughly 10 per cent, more than double the rate in people who had not had a previous sleep problem. This study is particularly significant due to the large population sample size and the use of general as opposed to clinical populations, which lends weight to the findings that insomnia specifically increases the risk of developing bipolar disorder. Etain’s findings dovetail neatly with a report from the “American Journal of Psychiatry” in April 2011 by a team from the University of Texas Southwestern Medical Center – E. A. Nierenberg et al. – on a 12-month clinical trial of sleep deprivation as a remedy for depressive symptoms. The study – which used a sample of around 70 men and women with confirmed clinical depression – found that nearly 40 per cent experienced an elevated mood, either as distinct hypomanic episodes or as a general reduction in depressive symptoms, after just one night of sleep deprivation. However, the study also indicated a distinct lack of response to such sleep therapies in people with current or previous diagnoses of bipolar disorder – the mood elevation response occurred exclusively in the unipolar depression group. Prof. Felipe S. A. Fregni, the senior author on the paper, suggested that the results could lead to the development of a form of deep brain stimulation treatment that mimics the effects of sleep deprivation, without the occurrence of mania in bipolar patients. This represents a promising line of clinical research into preventive treatments for reducing the risk of bipolar onset in those who have experienced depressive episodes related to sleep disruption. These findings are significant because they suggest a direct biological mechanism for sleep affecting the brain in such a way that increases the susceptibility to, or directly triggers, bipolar disorder. If the hypothesis that sleep deprivation, through the same cognitive overstimulation pathway, is found to cause lasting neural changes that can take a milder mood disorder into full hypomania or mania, it would be a breakthrough in the early treatment, particularly in a pre-clinical context. Further to this, research is progressing into more advanced methods of monitoring and tracking sleep disturbances, including using wearable data technology for participants in sleep and mood studies, in order to clarify further the long-term relationships between sleep and physiology in the risk of developing bipolar disorder and related conditions. These new technologies could represent starting points for clinically applicable research that may well provide an objective predictive tool based on sleep and circadian data for physicians in the near future. Such preventative methods are becoming all the more important in the shadow of the rising prevalence of bipolar diagnoses – with the “International Journal of Bipolar Disorders” reporting in March 2013 that cases had increased by nearly 67% in the UK between 2004 and 2014 – and with ever-growing waiting lists and strain on mental healthcare provisions, the possibility of intervention and prediction through something as simple as a good night’s sleep is an exciting prospect for patients. Thanks for reading and feel free to check out my other pieces on science and psychology!
4. Managing Sleep Deprivation in Bipolar Disorder
By enacting suitable sleep hygiene strategies like the ones outlined, an individual suffering from bipolar disorder may be provided with significant improvements in the quality of their sleep. Developing such regular, enjoyable and relaxing patterns may eventually prove easier and the positive impacts on health and mood alike are clear. Well-maintained sleep hygiene can then promote better mental and physical health.
Finally, the sleep environment should be made as comfortable as possible. Initiating a regular universal bedtime and wake time every day can help to regulate your body’s internal clock. The sleep environment should be cool, quiet, and dark with a comfortable place to sleep. It is important to try to associate the bed with only sleep and sex. This means that stimulating activities such as reading, watching TV and eating should be avoided. If sleep cannot be initiated after 15 to 20 minutes in bed, it is advised to go to another room and engage in a non-stimulating activity until the feeling of sleepiness is experienced.
Caffeine and alcohol should also be avoided especially within 6 hours of expected sleep. It is well known that the stimulating effect of caffeine can cause insomnia for some people and exacerbate anxiety symptoms in individuals with bipolar disorder. On the other hand, while alcohol is a depressant and can induce sleep initially, it will disrupt sleep during the night.
Physical exercise is vitally important for healthy sleep in bipolar disorder. Getting regular physical exercise can improve the quality of sleep and reduce the number of sleep disturbances. For example, even adding a short 30-minute walk into your daily routine can help to regulate your body’s sleep patterns. However, it is important not to exercise too close to the bedtime as it can act as a stimulant.
One important belief about sleep is that quality is more important than quantity. This means that it is essential to get up after an established period of time if sleep is not happening. Spending excessive time in bed can lead to fragmented and shallow sleep which can worsen mood swings. Hence, it is always better to undershoot sleep rather than oversleep.
A key component of successful bipolar disorder treatment is the regulation of healthy sleep habits. This is commonly referred to as “sleep hygiene”. Sleep hygiene in bipolar disorder treatment involves making changes in your lifestyle to ensure you have the best possible chance of getting a good night’s sleep. These changes help to alleviate your symptoms and further prevent mood swings. There are many components to sleep hygiene including attitudes and beliefs about sleep, stimulating activities, substance use, diet and exercise as well as the sleep environment.
4.1 Importance of sleep hygiene in bipolar disorder treatment
It is particularly important to consider sleep hygiene when treating children with bipolar disorder. This is because good sleep habits and practices in childhood can lay the foundations for a lifetime of healthy sleep. It is essential that the treatment plan takes this into consideration and that the child’s usual care providers are also educated in how to optimize the child’s sleeping patterns.
Some people with bipolar disorder may be quick to dismiss routines and self-help strategies as they could feel that gaining knowledge and making decisions for themselves takes away the insulation and security that may come from trusting others to take care of them. This can be part of a reforming package to help people with the condition maintain a lifestyle that is as healthy as possible and a belief in their own resources. It has been shown that amongst people suffering from mental disorders, those with bipolar disorder have the worst rates of sleep disturbances, and understanding and applying sleep hygiene within a detailed treatment plan is crucial. It is not to be disregarded, however, that medication such as the class of drugs “hypnotics” aimed to promote sleep in the early stages of treatment, while sleep hygiene education and cognitive behavioral therapy for insomnia are implemented.
Importance of sleep hygiene in bipolar disorder treatment. Bipolar disorder is a mental health condition characterized by periods of intense low mood and high mood. These can be distressing and disruptive to everyday life. People with bipolar disorder often experience erratic and disturbed sleep. Maintaining good sleep hygiene is therefore a key part of the management plan for bipolar disorder. Sleep hygiene is a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness. These practices can be useful for everyone, not just those with bipolar disorder. Given what a significant difference sleep can make to someone’s state of mind, it is important to give sleep hygienic practices the time and attention they deserve.
4.2 Pharmacological interventions for sleep disturbances
Various medications may be used to help an individual with bipolar disorder to sleep or to stay awake during the day. The most popular groups of drugs currently prescribed are benzodiazepine hypnotics, non-benzodiazepine hypnotics, and melatonin agonists for sleep, and modafinil and armodafinil for wakefulness. The decision to use hypnotics may be complex in patients with bipolar disorder. This is because patients may suffer mood instability due to sleep disruption but also because some hypnotics carry a risk of switch into mania. Benzodiazepine hypnotics, for example, should be avoided where possible because of their potential to depress mood and may also cause dependence, leading to potential problems with tolerance and the withdrawal effects if the patient stops the drug. Also, the long-term use of hypnotics may disrupt the structure of sleep, although this is not necessarily relevant to patients with bipolar disorder who commonly already have disrupted sleep. All hypnotic drugs may be associated with the development of tolerance. It should be noted, however, that there are very few short-term trials of hypnotic treatments for sleep problems in patients with bipolar disorder. This means that it is difficult to know specifically which hypnotic is best for these patients, and more information would be extremely useful to both psychiatrists and the patients that they are working with.
4.3 Non-pharmacological interventions for improving sleep quality
In contrast to pharmacological interventions, non-pharmacological treatments aim to alter disordered sleep without the side effects of drugs. It is noted that sleep deprivation has been shown to worsen the symptoms of bipolar disorder over time, and so restoring healthy sleep patterns is a key part of a long-term treatment plan. Firstly, Cognitive Behavioural Therapy, or CBT, has been found to help insomnia in many cases. The idea behind CBT is that it can change problematic sleep habits and the way someone thinks about sleep. Usually, the therapy will involve keeping a sleep diary, which is a record of the pattern of sleep and waking, and measuring how this matches up to periods of low or irritable mood. CBT for sleep deprivation will often include relaxation and distraction techniques as well as psychoeducation – that is, informing the patient about the disorder and self-help strategies. In recent years, research has found that the timing of treatment can have an effect on how successful light therapy may be. Light therapy is used to treat insomnia and other sleep disorders, but also seasonal affective disorder, where mood drops with the reduction in natural light over winter. It requires that the patient sit by a strong light (of at least 2,500 lux, a unit of light intensity) for around thirty minutes to an hour, either as soon as they wake up or in the evening, depending on the pattern of sleep. This can affect the production of melatonin, the hormone which regulates the body’s natural sleep-wake cycle, and so many experts believe that it is important to find the right time of day for exposure. However, a European study coordinated by the University of Oxford and including research teams from the UK, Portugal, Russia, and the Netherlands has found that the genetic make-up of a person may influence whether light therapy works at any given time. This is because the study found that variations in a gene called “Cry1” were linked to different responses to light therapy. Hence, doctors may be able to use a gene test to work out the best time to use this intervention, in what is sometimes called “personalised medicine”. It seems likely that an increasing understanding of how light affects the brain in changing sleep patterns will lead to more targeted and effective treatment in the future.

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