Bipolar Disorder and Sleep Problems

How Bipolar Disorder Affects Sleep: Get Better Sleep With Bipolar Disorder

Changes in sleep that last for more than two weeks or interfere with your life can point to an underlying condition. Of course, many things may contribute to sleep problems. Here's what you need to know about the many connections between bipolar disorder and sleep and what you can do to improve your sleep.

How Bipolar Disorder Affects Sleep

Bipolar disorder may affect sleep in many ways. For example, it can lead to:

  • Insomnia, the inability to fall asleep or remain asleep long enough to feel rested (resulting in feeling tired the next day).
  • Hypersomnia, or over-sleeping, which is sometimes even more common than insomnia during periods of depression in bipolar disorder.
  • Decreased need for sleep, in which (unlike insomnia) someone can get by with little or no sleep and not feel tired as a result the next day.
  • Delayed sleep phase syndrome, a circadian-rhythm sleep disorder resulting in insomnia and daytime sleepiness.
  • REM (rapid eye movement) sleep abnormalities, which may make dreams very vivid or bizarre.
  • Irregular sleep-wake schedules, which sometimes result from a lifestyle that involves excessive activity at night.
  • Co-occurring drug addictions, which may disrupt sleep and intensify pre-existing symptoms of bipolar disorder.
  • Co-occurring sleep apnea, which may affect up to a third of people with bipolar disorder, which can cause excessive daytime sleepiness and fatigue.

During the highs of bipolar disorder (periods of mania), you may be so aroused that you can go for days without sleep without feeling tired the next day. For three out of four people with bipolar disorder, sleep problems are the most common signal that a period of mania is about to occur. Sleep deprivation, as well as jet lag, can also trigger manic or hypomanic episodes for some people with bipolar disorder.

When sleep is in short supply, someone with bipolar disorder may not miss it the way other people would. But even though you seem to get by on so little sleep, lack of sleep can take quite a toll. For example, you may:

  • Be extremely moody
  • Feel sick, tired, depressed, or worried
  • Have trouble concentrating or making decisions
  • Be at higher risk for an accidental death

You may already know the ups and downs of how bipolar disorder affects sleep. But even between acute episodes of bipolar disorder, sleep may still be affected. You may have:

  • Heightened anxiety
  • Worries about not sleeping well
  • Sluggishness during the day
  • A tendency to have misperceptions about sleep

 

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Get Better Sleep With Bipolar Disorder

Disrupted sleep can really aggravate a mood disorder. A first step may be figuring out all the factors that may be affecting sleep and discussing them with your doctor. Keeping a sleep diary may help. Include information about:

  • How long it takes to go to sleep
  • How many times you wake up during the night
  • How long you sleep all night
  • When you take medication or use caffeine, alcohol, or nicotine
  • When you exercise and for how long

Certain bipolar medications may also affect sleep as a side effect. For example, they may disrupt the sleep-wake cycle. One way to address this is to move bedtime and waking time later and later each day until you reach your desired goal. Two other ways to handle this situation are bright light therapy in the morning and use of the hormone melatonin at bedtime, as well as to avoid bright light or over-stimulating activity near bedtime. This can include exercise and TV, phone, and computer screens.

Of course, your doctor may recommend a change in medication if needed. Be sure to discuss any other drugs or medical conditions that may be affecting your sleep, such as arthritis, migraines, or a back injury.

Restoring a regular schedule of daily activities and sleep -- perhaps with the help of cognitive behavioral therapy -- can go a long way toward helping restore more even moods.

Steps like these may also help restore sleep:

  • Eliminate alcohol and caffeine late in the day.
  • Keep the bedroom as dark and quiet as possible and maintain a temperature that is not too hot or cold. Use fans, heaters, blinds, earplugs, or sleep masks, as needed.
  • Talk with your partner about ways to minimize snoring or other sleep habits that may be affecting your sleep.
  • Exercise, but not too late in the day.
  • Try visualization and other relaxation techniques.
  • Try to unplug from the TV, laptop or your phone earlier.

 

 

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on May 1, 2017

Sources

SOURCES:

Depression and Bipolar Support Alliance: "Sleepless in America: Are You Moody or Irritable?;"  "Sleepless in America: Information for Families;" and "Sleepless in America: What's Keeping You Up All Night?"

Fieve, R. Bipolar II:Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression--The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder, Rodale Books, 2006.

Harvey, A. American Journal of Psychiatry, 2005.

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