It seems like an exaggeration or a meaningless stereotype, but for many people it is a harsh reality. Sleep cycles in depression typically swing one of two ways. In the first, a person is unable to sleep when they try. This is insomnia. The second way sleep is affected in bipolar depression is when a person sleeps considerably more than is normal for them. This is known as hypersomnia.
The word hypersomnia stems from two Greek words, “hyper” meaning over or excess and “somnus” or “somnia” meaning sleep. So, this symptom of depression basically means “excessive sleep.” It can also be known as hypersomnolance disorder.
About 30% of people with major depressive disorder experience hypersomnia. It is even more common in bipolar disorder, especially with atypical depression, with estimates from 38-78%. Among the general population, that rate is only 4-6%. Excessive sleep is also not limited to periods of depression, but can occur between episodes as well.
In bipolar disorder, there are two distinct types of excessive sleep. The first is dubbed “long sleep.” In long sleep, people with bipolar disorder stay in bed longer than normal. The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) defines long sleep as sleeping a total of 10 hours or more in a day (napping included) or two or more hours exceeding the normal amount of sleep individuals get when they are not experiencing hypersomnia. However, studies have found that long sleepers may not actually sleep longer than normal, they are simply in bed for longer periods. Long sleep outside of a depressive episode may predict an upcoming episode.
The second type of hypersomnia is excessive sleepiness. In this type, the person experiencing hypersomnia is in bed for an average amount of time, but is still tired. They experience daytime sleepiness, excessive need for sleep, and prolonged grogginess. This type of hypersomnolence may predict mania or hypomania.
Other than simply sleeping too much, there are other symptoms that come with hypersomnia:
- Daytime sleepiness
- Increased anxiety or irritation
- Decreased energy
- Problems thinking clearly
- Lack of appetite
- Memory problems
There are few treatment options available for hypersomnia. When excessive sleepiness is deemed a side effect of medication, which is very common in bipolar disorder treatments, lowering the dose of the medication or using a different medication may be necessary.
The drug modafinil (Provigil) is a stimulant that has been studied for its effectiveness in treating hypersomnia in bipolar disorder. The effectiveness rate was 39-44%. The drug does come with side effects including headache, nausea, rapid heart rate and insomnia. Like other stimulants, Provigil’s use in bipolar disorder carries a risk of inducing manic or hypomanic episodes.
Bright light therapy is also an option. One study found that women who used light therapy in the mid afternoon suffered fewer depressive symptoms overall. This may or may not include hypersomnia. The same study also found that early morning treatment may cause mixed episodes. This study was just a preliminary study with a small sample size, so should not be considered conclusive.
Sleep problems are exceptionally common in bipolar disorder and are primary symptoms for both mania and depression. People who experience sleep problems should contact their mental health professionals. Adjusting overall treatment for bipolar disorder may solve problems with sleep.
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