Bipolar Insomnia: The Connection Between Bipolar Disorder And Disturbed Sleep Habits

Medically reviewed by April Justice, LICSW and Dr. April Brewer, DBH, LPC
Updated October 28, 2024by BetterHelp Editorial Team

While people don’t always associate insomnia with bipolar disorder, sleep disturbances can be a common symptom of bipolar disorder. Not only can irregular sleep be a symptom of bipolar disorder, but it can also exacerbate other symptoms. Implementing various lifestyle changes—such as a set bedtime, relaxing nightly rituals, daily exercise, and avoiding screen time before bed—can improve sleep, address insomnia, and alleviate symptoms of other sleep disorders, like sleep apnea. Working with a licensed therapist in person or through an online therapy platform can also be helpful for addressing insomnia and the symptoms of bipolar disorder.

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Are you living with insomnia and bipolar disorder?

What is bipolar disorder?

Bipolar disorder is a mood disorder typically characterized by both manic and depressive episodes. According to the National Institute of Mental Health, bipolar disorder “causes unusual shifts in a person’s mood, energy, activity levels, and concentration”. Episodes of mania and depression may last for days, weeks, or months. There are three primary bipolar disorders: bipolar I, bipolar II, and cyclothymia.

Bipolar disorder is considered to be relatively common—about 2.8% of adults in the United States are thought to live with this mental illness each year. Bipolar disorder often presents during early adulthood, but symptoms can also appear earlier or later in life.

While the exact causes of this mental health condition are not currently known, it is theorized that environment, genetics, and an altered brain structure may all play a part.

Bipolar insomnia treatment and its impact on mental health

The treatment for bipolar disorder is often lifelong, as the condition is not usually something that can be "cured". Treatment often involves medication and psychotherapy. Common forms of medication for bipolar disorder are mood stabilizers, antipsychotics, and antidepressants. An individual’s medication regimen will typically depend on the type of bipolar disorder they’re experiencing, their medical history, and a variety of other factors. Never start or stop any form of medication unless under the guidance of a licensed medical professional.

Therapeutic approaches

Specific therapeutic approaches can be used to help with manic and depressive episodes, and a licensed therapist may be able to identify the correct type of therapy for each individual. Research suggests that combining psychotherapy with medication can decrease the burden of symptoms and lower the risk of relapse. Common therapeutic modalities for bipolar disorder are cognitive behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and dialectical behavior therapy. 

Symptoms of bipolar disorder

There are many potential symptoms of bipolar disorder.

When someone is in a manic phase, they will usually appear to be full of nervous energy. They might talk quickly and jump from topic to topic. They will probably be very active, and they might feel that they can do many things at once. You may see them start new projects, spend money recklessly, or engage in risky sexual behaviors. They may also use recreational drugs as a way of self-medicating. They will typically not be able to be pragmatic in their thinking, and they may scoff at you if you try to help them.

If they are in a depressive phase, then they will likely feel depressed, sad, or moody. They may be unable to take joy in any of the activities that would normally interest them. As we’ll discuss below, for individuals with bipolar disorder, sleep disruptions can also be a common concern. 

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What about insomnia and bipolar disorder?

There is thought to be a bidirectional relationship between bipolar disorder symptoms and disrupted sleep, meaning mood symptoms may contribute to sleep difficulties, and sleep abnormalities can exacerbate bipolar depression or mania. Research supports the existence of this connection. In a systematic review and meta-analysis, researchers found that disruptions to the sleep-wake cycle are associated with a 40% increased risk of developing bipolar disorder in individuals who are predisposed to the condition. 

As with other psychiatric disorders that affect an individual’s mood (e.g., unipolar depression), bipolar disorder can be associated with insomnia, as well as excessive sleep. Those who have bipolar disorder may experience insomnia either in a manic or a depressive phase, as well as when their mood is stable

Sleep plays a major role in bipolar disorder

Many people understand that insomnia can occur during a manic episode. In fact, 69 to 99% of individuals experience a decreased need for sleep during a manic episode. During these periods, individuals will likely feel energized despite their lack of sleep.

Insomnia, as well as excessive sleep, can occur during depressive episodes. However, unlike manic episodes, this insomnia is likely to occur with feelings of tiredness. Individuals living with bipolar disorder may also experience insomnia when their moods are stable. 

Bipolar disorder may affect sleep in many ways

Disruptions in sleep can lead to significant challenges for those living with bipolar disorder. Sleep disturbance in bipolar disorder can lead to excessive daytime sleepiness, negatively impacted treatment outcomes, and recurrence of a mood episode. As researchers explained in a study published in the journal Sleep Medicine Clinics (Sleep Med Clin), “Sleep disturbance is associated with decreased quality of life and mood relapse in bipolar disorder”. Bipolar disorder has also been linked to rapid eye movement (REM) sleep abnormalities; in fact, some experts believe these disruptions are a risk factor for the condition. REM sleep is a phase of the sleep cycle that is considered important to cognitive functioning so that a sleep disturbance may have an impact on memory and other crucial processes in an individual with bipolar disorder. 

Sleep disturbance is a core symptom of bipolar disorder

Some research suggests that sleep disturbance may be a marker for the onset of bipolar disorder in children. Additionally, a decreased need for sleep may help professionals distinguish bipolar disorder from other mental illnesses. In addition to insomnia, bipolar disorder is associated with sleep disorders like sleep apnea and (as we’ll discuss below) delayed sleep phase syndrome. 

Delayed sleep phase syndrome and bipolar disorder

Like insomnia, delayed sleep phase syndrome (DSPS) is a sleep disorder that commonly co-occurs with bipolar disorder and causes difficulty falling asleep and irregular sleep schedules. People with DSPS experience disruptions to their circadian rhythms, causing them to fall asleep and wake up later than is recommended or considered typical. A change in circadian rhythm can cause daytime sleepiness, cognitive challenges, and worsening symptoms of affective disorders like bipolar disorder. Sleep quality can improve, however, when an individual with DSPS focuses on stabilizing their sleep-wake cycle. Bright light therapy—in which individuals are exposed to light sources to control their circadian rhythms—is thought to be an effective treatment for those who are living with sleep disturbance in bipolar disorder due to DSPS. 

Treatment for insomnia and bipolar disorder

As mentioned above, insomnia can be both the cause of and a symptom of manic and depressive episodes. Along with seeking treatment for symptoms of bipolar disorder, individuals may need to seek treatment for their insomnia to avoid chronic sleep deprivation or other disturbances. When addressing sleep disturbances, sleep aids can be one option, but lifestyle changes may also help people with sleep disturbances get better sleep.

Exercise

Exercising may help individuals combat the effects of sleep disturbance in bipolar disorder. At least 30 minutes of moderate-intensity aerobic activity may help with sleep quality. Research suggests that physical activity may help patients with bipolar disorder stabilize their sleep-wake cycles. However, since exercise can also release endorphins that may prevent sleep, it’s usually best to exercise at least two hours before bedtime.

The type of exercise doesn’t necessarily matter, as long as it is at least moderate in intensity and raises the heart rate. Patients with bipolar disorder may consider swimming laps in a pool, partaking in a dance aerobics class, briskly walking around a park, or playing a sport like racquetball.

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Are you living with insomnia and bipolar disorder?

Are you living with insomnia and bipolar disorder?

It may also be helpful to go to bed at the same time each night. If an individual goes to bed at 9 PM one night and midnight the next, it can be difficult for their body to understand when it is supposed to wind down.

Along with going to bed at the same time, individuals should generally try to get up each morning at approximately the same time as well. Sleeping in an extra hour on the weekends is likely fine, but any more than that should normally be avoided.

Reduce screen time

Although screens may seemingly be omnipresent in today’s world, individuals should generally do their best to limit screen time before bed. Taking a break from TV, computers, and phones at least an hour before bedtime can help the body prepare for sleep. Instead of turning to screens before bed, some alternative options may include reading a book, completing a jigsaw puzzle, listening to an audiobook, or coloring in an adult coloring book. For those who are experiencing manic or hypomanic episodes, dark therapy (in which amber lenses are worn) is often used to limit blue light exposure and improve sleep.

Establish relaxing rituals

Part of falling asleep can be training one’s mind to be less active, and calming nighttime rituals may help with this. Some options may include taking a warm bath, enjoying a cup of herbal tea, or completing a slow yoga flow.

Seeking help for insomnia and bipolar disorder

Insomnia can be frustrating, especially when you feel like you’ve taken steps to improve your sleep. While it may feel like you will never be able to sleep normally again, help is available. Therapy can be a way for you to discuss your worries regarding insomnia and bipolar disorder, and it can also help you figure out ways to manage your symptoms. However, if you’re sleep-deprived, you may find it difficult to meet with a therapist in person. Online therapy can empower you to connect with a licensed therapist from anywhere you have a strong and stable internet connection, which often makes therapy more effective.

Online cognitive behavioral therapy (CBT) may help individuals living with insomnia improve their sleep. By working with a therapist to recognize and change negative thought patterns, you may be able to decrease your insomnia. In general, online therapy has the same efficacy rate as traditional in-office therapy.

Takeaway

Insomnia and bipolar disorder often occur together. Sometimes, insomnia can be a sign of bipolar disorder, and it may also exacerbate the symptoms of bipolar disorder. Lifestyle changes, like daily exercise, having a set bedtime and waking time, reducing screen time before bed, and practicing relaxing nightly rituals, may make it easier to get plenty of restful sleep. Working with professionals to manage both insomnia and bipolar disorder can result in an improved quality of life as well. One way to connect with a licensed mental health professional may be through an online therapy platform.

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