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Mood Disorders and Sleep

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Updated October 11, 2010

Do you find yourself sleeping 12 or 14 hours at a time? Is your husband staying up all night? If you have been accepting these strange sleep patterns as part of your depression or bipolar disorder, you may be pleased to learn that changing the way you sleep might significantly improve your condition.

What may surprise you is that reduced sleep isn't just a symptom of mania - a short night can actually precipitate manic and hypomanic episodes. Studies have found that 25 to 65 percent of bipolar patients who had a manic episode had experienced a social rhythm disruption prior to the episode. "Social rhythm disruption" is some disturbance in routine affecting the sleep/wake cycle; it can be as simple as staying up extra late to watch a movie on television or getting wrapped up in an interesting online chat session, or as serious as being unable to sleep due to a family member's serious illness or death. "For reasons we have yet to learn, people with bipolar disorder seem to have more delicate internal clock mechanisms," said Dr. Ellen Frank, co-author of one of the studies. And once a sleep-deprived person has gone into mania, if he then feels less need for sleep (parasomnia) and, by staying awake perhaps 20 or more hours a day, is actually contributing to making the mania worse.

Some scientists believe that the reason the incidence of bipolar disorder has risen in modern times is the development of bright artificial light. Once upon a time, most people's sleep/wake cycles were regulated by the sun. Artificial light changed all that, and made it more likely that people who have a genetic predisposition toward bipolar disorder would actually develop the condition.

Interestingly, 85% of patients with unipolar depression report that they suffer from insomnia, even though bipolar patients tend to experience hypersomnia - excessive sleeping - during depressive episodes. Hypersomnia is also a characteristic of Seasonal Affective Disorder - along with decreased quality of sleep, which is also found in depressive patients, whether insomniac or hypersomniac. This poor-quality sleep can, in turn, lead to fibromyalgia, a painful, nondegenerative muscle disorder. All these patients can benefit from good "sleep hygiene" - a disciplined regularizing of sleep/wake hours. Depressed patients and those with fibromyalgia are also often treated with antidepressants such as amitriptyline and trazodone, which have sedating effects.

Patients suffering from insomnia and hypersomnia are told to go to bed at the same time each day, and get up at the same time. Naps are forbidden. Insomniacs should not stay in bed if they can't sleep, but are to get up at the same time no matter how little sleep they have had. Hypersomniacs are advised to gradually reduce the amount of time spent sleeping to a normal amount by using an alarm clock.

Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may be of particular help for treatment-resistant rapid cycling bipolar disorder. Such therapy may begin by enforcing complete light and sound deprivation for as many as 14 hours per night, which can be gradually reduced once the patient's moods are seen to stabilize.

Doctors point out the need to involve the patient's family in the effort to regularize the sleep/wake cycle. Family members should be taught about the patient's vulnerability to changes in daily routine. After all, a husband's "Oh, honey, I know the party will last all night but can't we do it just this once?" could send "honey" straight into a manic episode. Family members also need to learn the signs of an episode's onset, whether manic, hypomanic or depressive, and be prepared to intervene before the mood swing becomes full-blown.

If you or a loved one suffer from any type of mood disorder, pay attention to the sleep/wake patterns of the person involved. If you identify insomnia, hypersomnia, poor-quality sleep and/or reduced need for sleep, this should be brought to your/your loved one's doctor's attention right away. Treating the sleep disorder is very likely to improve the mood disorder, too.

References/Suggested Reading:

Disruptions in Sleep May Lead to Mania in Bipolar Disorder
Report on studies presented in 1997 at the Second International Conference on Bipolar Disorder, which found strong correlation between sleep deprivation and manic episodes.

Meeting the Challenge of Rapid-Cycling Bipolar Disorder
Reported in depth on a case study where aggressive sleep management stabilized a patient who had been resistant to conventional treatment. (Article no longer online)

Sleep Treats Mania in Bipolar Disorder
Reported on the same case study, as well as discussing the effects of sleeping at different times of the day. (Article no longer online)

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  6. Sleep and mood disorders - how sleeping affects bipolar episodes and cycling

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