Healthy Sleep Cycles = Stability
Research suggests a strong relationship between a person’s ability to regulate sleep adequately and regulating mood. Allison G. Harvey, PhD describes how the relationship between daytime mood regulation problems and nighttime sleep disturbances can play out as a cycle where the sleep disturbances contribute to the mood problems, and the daytime mood problems can contribute to the sleep disturbance. [i] Such a cycle can eventually trigger a manic or depressive episode in the individual who lives with bipolar disorder.
Once an episode is triggered, sleep can be even more difficult to manage as mania is usually accompanied by a reduce need for sleep (causing sleep deprivation) and depression often causes either a desire to sleep much longer than what is healthy, or an inability to sleep adequately due to sleep disturbances. One very important step toward returning to a stable and balanced state is to reset and restore healthy sleep patterns.
In our last blog, we talked about healthy dietary hygiene to help with mood regulation during the day. Today, we will address some of the options mentioned in Allison G. Harvey’s research and suggestion for sleep treatments.
Pharmacotherapy: Common Pharmacotherapy treatments include benzodiazepine, antidepressants, and antihistamines. Benzodiazepines can be addictive and can cause cognitive and psychomotor impairments and/or additional risks. They are carefully monitored by the prescribing medical physician or psychiatrist.
Melatonin-related approaches: The research discussed a trial of 11 patients who experienced insomnia during a manic episode reporting positive results. I perceive this a promising as melatonin is a hormone that is natural and vital to the human physiology and is directly related to our ability to sleep.
Light Therapies: There is preliminary data suggesting that dark therapy may be helpful in reducing mood symptoms; the research paper mentions that research on the role of light therapy in the treatment of bipolar is needed. I did find a meta analysis that is promising in The American Journal of Psychiatry titled: The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-Analysis of the Evidence. This research suggests that bright light treatment and dawn simulation for seasonal affective disorder and bright light for non-seasonal depression are effective and comparable to most antidepressant pharmacotherapy trials. [ii]
Cognitive Behavior Therapy: Dr. Harvey discusses CBT-I as a multi-component treatment that targets factors directly related to sleep disturbances. Although she mentions a lack of studying this intervention in the context of bipolar disorder, the paper suggests the potential as positive as there is substantial evidence that CBT-1 is very effective in treating insomnia.
The above list is not all inclusive. If you enjoy reading research, you will benefit from reading Dr. Harvey’s thoroughly researched article. You will see the retrieval details below in the footnotes.
Finally, a reminder to keep you on track: Prevention is the best medicine. During times of relative stability, work on developing good sleep hygiene habits. Ensure that you have a good routine that is easy to keep that results in your going to bed around the same time each night. If you end up having one of those nights where you really can’t sleep, but it is bedtime, consider staying in bed. If you can’t handle the silence, and you feel too restless, you can turn on a dim light and journal, or read, or listen to soothing music. The idea is to stay in bed and rest. By resting, your body is still repairing itself and achieving many of the same benefits of actual sleep, and you will be less likely to feel drained in the middle of the day. This will help you stay awake and alert during the day, and increase the probability that you will be able to sleep closer to your routine time the next night.
[i] Sleep and Circadian Rhythms in Bipolar Disorder: Seeking Synchrony, Harmony, and Regulation
Allison G. Harvey , Ph.D.; http://dx.doi.org/10.1176/appi.ajp.2008.08010098 (retrieved 3/6/2015)
[ii] The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-Analysis of the Evidence:
Robert N. Golden, M.D.; Bradley N. Gaynes, M.D., M.P.H.; R. David Ekstrom, M.A., M.P.H.; Robert M. Hamer, Ph.D.; Frederick M. Jacobsen, M.D., M.P.H.; Trisha Suppes, M.D., Ph.D.; Katherine L. Wisner, M.D.; Charles B. Nemeroff, M.D., Ph.D. http://dx.doi.org/10.1176/appi.ajp.162.4.656 (Retrieved 3/6/2015)