Anyone with bipolar disorder knows that sleep is a problem. In fact, sleep disturbance is reported during episodes of mania and depression over 90% of the time.
For people like me who rapid-cycle, insomnia occurs during episodes always. 100% of the time according to a study from UC Berkley.
Sleep disturbance is the most common predictor of an oncoming episode. While insomnia hits us with obvious distress, the real culprit may be sleep latency.
Sleep latency is the length of time it takes to progress from full-awake to sleep. Longer latency can reduce REM sleep and precipitate mania and/or depression. But when latency lengthens, you may not want to get up and move around.
The study details how researchers have used darkness therapy to stop manic episodes. People in manic episodes were put to bed in dark rooms for fourteen hours for three nights. Rarely did they sleep most, or even much of the time. But after three nights spent this way most subjects’ episodes of mania stopped.
Sleep disturbance can make moods swing both ways. In people with bipolar disorder experiencing depression, one missed night of sleep, defined as being awake for 40 hours, led to 7 out of 9 people shifting into a manic or hypomanic episode.
The message is to get a good night’s sleep. But that’s not an easy thing to do, and on top of the influence of sleep on mood, and mood on sleep, there’s the complicating factor of medication.
As the researchers concede, it’s difficult to attribute the pure influence of sleep disturbance since medication itself can make sleep patterns difficult to monitor. The subjects of the study took a variety of psych meds. The researchers were unwilling to add a study group without meds since removing people from meds for the length of the study was decided to be too dangerous.
Interestingly though, the researchers did look at lifestyle issues like obesity and smoking that are commonly co-morbid with bipolar disorder and are greatly influenced by or on sleep.
Most people with bipolar disorder are overweight, and over 30% are obese. Obesity is much more common in people who get fewer than 5 hours of sleep a night. Again we face issues of causation vs correlation, as it’s unclear whether the lack of sleep contributes to the weight gain or if the extra weight, through problems like sleep apnea, contributes to the lack of sleep.
The influence of smoking on sleep is more clear cut. More people with bipolar disorder smoke (60%) than people in any other measurable category. Smoking significantly increases sleep latency, which makes mood swings much more likely. Sleep latency caused by smoking is also noted as a predictor of poor impulse control, which can be deadly during manic, depressive or mixed episodes.
For many people with bipolar disorder the best remedy for sleep disturbance is to quit smoking.
It’s ironic that I’m writing this at 3:00am. I fell asleep fine, but I woke up in the middle of the night and can’t find my way back to bed. According to the study, tomorrow I’m likely to be irritable and confrontational. I’m afraid the people who live with me will agree.
My book Resilience: Handling Anxiety in a Time of Crisis is available now.