by Marcia Purse
Do you find yourself sleeping 12 or 14 hours at a time? Is your husband staying up
all night? If you have been accepting these strange sleep patterns as part of your
depression or bipolar disorder, you may be pleased to learn that changing the way you
sleep might significantly improve your condition.
What may surprise you is that reduced sleep isn't just a symptom of mania - a short
night can actually precipitate manic and hypomanic episodes. Studies have
found that 25 to 65 percent of bipolar patients who had a manic episode had
experienced a social rhythm disruption prior to the episode. "Social rhythm
disruption" is some disturbance in routine affecting the sleep/wake cycle; it can be
as simple as staying up extra late to watch a movie on television or getting wrapped
up in an interesting online chat session, or as serious as being unable to sleep due
to a family member's serious illness or death. "For reasons we have yet to learn,
people with bipolar disorder seem to have more delicate internal clock mechanisms,"
said Dr. Ellen Frank, co-author of one of the studies. And once a sleep-deprived
person has gone into mania, if he then feels less need for sleep (parasomnia) and, by
staying awake perhaps 20 or more hours a day, is actually contributing to making the
Some scientists believe that the reason the incidence of bipolar disorder has risen
in modern times is the development of bright artificial light. Once upon a time, most
people's sleep/wake cycles were regulated by the sun. Artificial light changed all
that, and made it more likely that people who have a genetic predisposition toward
bipolar disorder would actually develop the condition.
Interestingly, 85% of patients with unipolar depression report that they suffer from
insomnia, even though bipolar patients tend to experience hypersomnia - excessive
sleeping - during depressive episodes. Hypersomnia is also a characteristic of
Seasonal Affective Disorder - along with decreased quality of sleep, which is also
found in depressive patients, whether insomniac or hypersomniac. This poor-quality
sleep can, in turn, lead to fibromyalgia, a painful, nondegenerative muscle disorder.
All these patients can benefit from good "sleep hygiene" - a disciplined regularizing
of sleep/wake hours. Depressed patients and those with fibromyalgia are also often
treated with antidepressants such as amitriptyline and trazodone, which have sedating
Patients suffering from insomnia and hypersomnia are told to go to bed
at the same time each day, and get up at the same time. Naps are forbidden.
Insomniacs should not stay in bed if they can't sleep, but are to get up at the same
time no matter how little sleep they have had. Hypersomniacs are advised to gradually
reduce the amount of time spent sleeping to a normal amount by using an alarm
Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may
be of particular help for treatment-resistant rapid cycling bipolar disorder. Such
therapy may begin by enforcing complete light and sound deprivation for as many as 14
hours per night, which can be gradually reduced once the patient's moods are seen to
Doctors point out the need to involve the patient's family in the
effort to regularize the sleep/wake cycle. Family members should be taught about the
patient's vulnerability to changes in daily routine. After all, a husband's "Oh,
honey, I know the party will last all night but can't we do it just this once?" could
send "honey" straight into a manic episode. Family members also need to learn the
signs of an episode's onset, whether manic, hypomanic or depressive, and be prepared
to intervene before the mood swing becomes full-blown.
If you or a loved one suffer from any type of mood disorder, pay attention to the
sleep/wake patterns of the person involved. If you identify insomnia, hypersomnia,
poor-quality sleep and/or reduced need for sleep, this should be brought to your/your
loved one's doctor's attention right away. Treating the sleep disorder is very likely
to improve the mood disorder, too.
Disruptions in Sleep May Lead to Mania in Bipolar
Report on studies presented in 1997 at the Second International
Conference on Bipolar Disorder, which found strong correlation between sleep
deprivation and manic episodes.
Meeting the Challenge of Rapid-Cycling Bipolar Disorder
Reported in depth
on a case study where aggressive sleep management stabilized a patient who had been
resistant to conventional treatment. (Article no longer online)
Sleep Treats Mania in Bipolar Disorder
Reported on the same case study, as
well as discussing the effects of sleeping at different times of the day. (Article no