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Sleeping With Bipolar Disorder

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Bipolar disorder is a type of mental illness. Scientists believe it occurs after traumatic events or as a genetic problem. People with bipolar disorder have periods of mania (extremely active, indulging in pleasurable activities, sometimes not sleeping for days) followed by periods of depression (continuous sadness, hopelessness, lack of activity). These periods typically last for days.

Bipolar disorder is strongly related to sleep. In many cases (especially for women) manic episodes are triggered by sleep deprivation. We know that sleep deprivation may cause a dopamine spike in some people, and this euphoria may actually act as a cause for the onset of mania.

This disorder usually comes together with insomnia, circadian rhythm problems, bizarre dreams, and poor sleep schedules. Here we talk about bipolar people, their sleep, and what they could do to improve it.

What is bipolar disorder?

Bipolar disorder is a mental illness – its main characteristics are big mood shifts. These shifts range from being extremely energetic and overly active to being depressed and unable to perform daily tasks. Every person has their own good and bad mood periods, but with bipolar disorder, these periods are more noticeable and more severe.

If manic episodes are not too severe they are called hypomanic episodes. A period in which a bipolar person is not going through an episode is euthymia.

Euphoric and depressive episodes may not shift too often. A bipolar person may spend most of the time in the depressive state, for example.

What are the types of bipolar disorder?

If a person only has depressive episodes, then he or she is not bipolar, just prone to depression.

If there is at least one manic episode, that’s called Bipolar I Disorder. These manic episodes may last for over a week, and symptoms of euphoria and increased activity may be so severe that the person could require help from hospital professionals.

In Bipolar I Disorder a person may experience very dangerous mixed periods (symptoms of mania and depression occurring at the same time). It’s dangerous because this phase carries the highest risk of suicides.

When there is a pattern of recurring depression and hypomania it is Bipolar II Disorder. Bipolar II is less severe than Bipolar I when it comes to mood elevation.

If there are not a few, but rather many periods of mild hypomania and mild depression over the course of at least two years, the person may be suffering from Cyclothymic disorder (cyclothymia). Although not severe it’s still obvious that there are cyclical repetitions in high and low mood periods.

The National Institute of Mental Health claims that about 5.7 million adult Americans suffer from bipolar disorder. That’s about 2.6% of the general population.

What does it feel like to have bipolar disorder? Symptoms

A manic episode characterizes a feeling of being ‘high’, elated, having plenty of energy at all times, and being more active than usual. Manic people think and talk fast, quickly switching from one topic to another. They also tend to try and do many things at once. However they are also irritable, have trouble sleeping and are likely to indulge in pleasurable activities including overeating, drug abuse, and reckless sexual activity.

A depressive episode is a complete opposite – people feel sad, empty, feel worthless, with no energy, and tired all the time. This may either cause them to sleep too little or way too much. They are less active than normal, keep worrying, and their feeding habits either include excessive food intake or food avoidance. They may even contemplate suicide.

During a mixed episode a person may feel hopeless and empty while at the same time full of energy and need for activity.

Common sleep problems of bipolar people

Bipolar disorder is linked to a number of sleep problems including getting an inadequate amount of sleep, sleep architecture, circadian rhythm problems, and various types of undesirable behavior.

  • Insomnia causes a lack of sleep. It is an inability to fall asleep or stay asleep. Insomnia usually happens during periods of mania. When overly active a person simply feels no need for sleep, although they may be very tired.
  • Hypersomnia is the excessive need for sleep or sleeping for a longer time than normal. It is a predominant problem among those in the depressive episode.
  • Delayed sleep-phase syndrome is a disorder of the circadian rhythm (biological clock; a system that dictates body rhythm for sleeping, waking up, feeding, and hormonal release). According to some research bipolar people have a circadian delay of over two hours – which means that their body acts as if it is two hours earlier in the day than it actually is, meaning they go to bed late and get up late. As our circadian rhythm relies on daylight to ‘tell time’, excessive exposure to artificial light at night can ‘trick’ and delay it. The use of caffeine, certain drugs and poor sleep hygiene can also play a big role in causing this problem.
  • Too much stage 1 sleep (light sleep) and REM abnormalities. Stage 1 sleep is the stage in which people with normal sleep don’t spend much time. We only go through this stage for a short time upon falling asleep. It’s very easy to wake up from stage 1, so those who spend a lot of time in this stage are likely to wake up often. When it comes to REM their rapid eye movement stage is fragmented and occurs frequently which also leads to wakings. They usually report unusual and bizarre dreams.
  • Obstructive sleep apnea (OSA). A large portion of people with bipolar disorder also suffer from OSA – a condition in which a person’s breathing gets obstructed many times each night, waking them up frequently.

    OSA is usually treated with a CPAP (continuous positive air pressure) machine, greatly mitigating OSA symptoms. However, when CPAP is used on a bipolar person it actually triggers a manic episode.

For all these reasons people with bipolar disorder have poor, non-restorative sleep and often suffer from the excessive daytime sleepiness, even during euthymia (‘normal’ period). This means that they often feel fatigue, have poor concentration and an inability to focus (short attention span).

Most people with bipolar disorder say that when their sleep disorders begin that a manic episode is also about to begin. As mentioned above; short-term sleep deprivation, such as a night out or staying up for work, can also trigger mania.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

How to sleep better with bipolar disorder

Sleep problems may arise from too much activity at night, low self-control (especially during mania), drug and alcohol consumption – therefore learning how to practice good sleep habits can be of great help.

  • Refrain from entertaining activities at night. Keep the lights dim, take a shower, drink calming tea, and/or read a book before bed. Winding down relaxes the body and prepares it for sleep. Things you like doing or consuming can increase your dopamine – which is good for making you happy, but dopamine also makes us awake, so try to avoid fun and action at night.
  • Don’t get exposed to artificial LED and screen lights at least a couple of hours prior to bedtime. Avoid any phone calls, work or any type of stressors. Watching a movie with a beer is definitely something to avoid.
  • Avoid alcohol and caffeine about 6 hours prior to sleep. Although alcohol can be relaxing, it actually impairs your sleep structure. Caffeine postpones sleep time and impairs sleep quality.
  • Make sleep and wake time schedule – let yourself have at least 7 hours dedicated to sleep and spend this time in bed. Regardless of how difficult it may be to always wake up on time, do your best to get up. You’ll find it easier to sleep well as you teach your body the proper time to sleep. Nobody’s circadian rhythm is able to adjust to an untidy schedule, and knowing how to behave is a great part of the solution.

More tips for good sleep

A study on sleep disorders in people with bipolar disorder has given us some recommendations on things every bipolar person should know.

Some beliefs you may have are simply not helping you. For example, falling asleep with a TV on is not good (it greatly impairs sleep quality). Some think that going to bed at a certain time is pointless – but they may be wrong – especially if they are trying to adjust to a new sleep schedule.

Do everything you can to reduce anxiety before bed – including the anxiety which may appear if you think you’ll have another sleepless night. Reserve your bed only for sleep so that you can associate bed with rest and relaxation.

Being groggy upon waking is normal. Most people have that feeling and you shouldn’t increase your sleep time just because you felt groggy in the morning.

Many are able to get a good night’s sleep after talking to a professional and fully understanding how much sleep hygiene can actually help. For many people sleep discipline just doesn’t occur as an option – but it can be greatly beneficial.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

Additional resources

  1. Bipolar Disorder. National Institute for mental health. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml Accessed April 17, 2019
  2. Harvey, Kaplan, et al. Interventions for Sleep Disturbance in Bipolar Disorder. Sleep Med Clin. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347516/ Accessed April 17, 2019
  3. Lewis, Gordon-Smith, et al. Sleep loss as a trigger of mood episodes in bipolar disorder: individual differences based on diagnostic subtype and gender. Br J Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5579327/ Accessed April 17, 2019
  4. Gold, Sylvia. The role of sleep in bipolar disorder. Nature and Science of sleep. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935164/ Accessed April 17, 2019
  5. Harvey, Talbot, Gershon. Sleep Disturbance in Bipolar Disorder Across the Lifespan. Clin Psychol (New York) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321357/ Accessed April 17, 2019
  6. Aggarwal, Baweja, et al. CPAP-induced mania in bipolar disorder: a case report. Bipolar Disord. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4208920/ Accessed April 17, 2019

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