Sleep in bipolar disorder

Did You Know?

• Bipolar disorder has high heritability, and sleep disturbances may have a genetic basis, with modest associations found between circadian rhythm genes (ARNTL and CLOCK) and the disorder.
• Sleep disturbance can persist as a residual symptom after manic or depressive episodes, negatively influencing functioning and recovery.

REM sleep in bipolar disorder

REM sleep is essential for processing episodic emotional memories. In both unipolar and bipolar depression, increased REM density has been observed. This may represent a failed attempt to reduce negative emotional experiences during sleep, or it could pathologically reinforce negative self-narratives and maintain negative moods after sleeping. Neither hypothesis is fully proven.

Sleep disorders and bipolar disorder

Bipolar disorder is associated with several comorbid sleep disorders, including insomnia, hypersomnia, delayed sleep phase syndrome, circadian-rhythm sleep disorder, sleep apnea, REM sleep abnormalities, and irregular sleep-wake schedules. Poor sleep quality and nightmares have been linked to an increased risk of suicidal ideation and suicidal attempts in these patients.

Treatment possibilities regarding the sleep disturbances in bipolar disorder

Interpersonal and social rhythm therapy (IPSRT) aims to regulate circadian rhythms and sleep–wake cycles by maintaining regular daily rhythms for exercising, eating, sleeping, and waking. Research indicates that the sleep-wake cycle can be moderated by social and volitional factors, and IPSRT uses this chronobiological model to manage bipolar symptomatology. Light therapy may be an effective augmentation strategy; one study found that four of five women receiving midday light responded well, while three of four receiving morning light developed a mixed state. Total or partial sleep deprivation can temporarily improve mood in depressed bipolar patients, but depressive symptoms often return after sleep. The internal coincidence model suggests that depressed patients sleep at the wrong biological clock time, and sleep deprivation works by preventing sleep at a critical phase, with misalignment reinstated during recovery sleep. The two process model of sleep proposes that depression involves a deficiency in process S buildup; sleep deprivation increases process S initially, but relapse occurs when deprivation stops and process S returns to a low level.