Bipolar Insomnia: The Connection Between Bipolar Disorder And Disturbed Sleep Habits
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.
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.
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.
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.
What does bipolar insomnia feel like?
It is well-documented that bipolar disorder can cause substantial sleep disturbances. Bipolar insomnia likely feels similar to other types of insomnia. Many people experience trouble falling asleep or staying asleep. Their sleep-wake cycle may also be shifted considerably; they might naturally feel sleep at 3 AM and wake up again at noon, similar to delayed sleep phase syndrome. Their longer sleep onset latency can substantially reduce the amount of high-quality sleep they can obtain. The experience is likely unpleasant, and people may struggle to feel alert and awake during their normal active hours.
Why do people with bipolar disorder have insomnia?
The sleep cycles of a person with bipolar disorder follow patterns based on whether they are experiencing a depressive or manic episode. Those in a depressive episode tend to sleep excessively, while those in a manic episode tend to experience substantial insomnia. During a manic or hypomanic episode, a person’s brain is up-controlled. They have more energy, likely feel more driven to complete tasks, and may struggle to relax. The persistent overstimulation characteristic of a manic episode prevents sleep onset and may make staying asleep difficult until the episode has passed.
How do you get a person with bipolar disorder to sleep?
Treating bipolar insomnia can seem overwhelming, but there are some basic steps a person can try before reaching out for professional help. One of the most important things to consider is maintaining good sleep hygiene. Sleep hygiene refers to habits and behaviors that enable a person to get to sleep quickly and stay asleep throughout the night. Ensuring good sleep habits is often the first step to addressing insomnia.
Tips for managing bipolar insomnia and sleep problems
Here are a few common tips for increasing the likelihood of a good night's rest:
Resist the urge to check the time. Anxiety associated with the amount of sleep a person is missing can make falling asleep harder.
Don’t use electronics like smartphones, tablets, laptops, or television for at least 60 minutes before bedtime. Evidence suggests that the stipulation from electronic devices can make it harder to fall asleep.
Make sure the sleeping area is comfortable, at a cool temperature, and free from excessive light.
Try relaxation strategies like progressive muscle relaxation, guided visualization, or meditation.
Why is bipolar disorder worse at night?
Evidence indicates that some factors can increase the likelihood of entering a depressive episode at night. Factors such as disturbed sleep, darkness, and reduced activity may increase the likelihood that a person switches into a depressive state in the middle of the night, especially for those with rapid-cycling bipolar disorder. Manic episodes can exacerbate sleep disturbances and may contribute to sleep deprivation, increasing the likelihood that a person may experience additional mood instability.
Can lack of sleep trigger bipolar disorder?
Lack of sleep is a well-known trigger for bipolar episodes. One of the primary behavioral interventions to address bipolar insomnia and other symptoms is ensuring that a person gets adequate sleep, eats a healthy diet, and gets regular physical activity. Maintaining a balance is important because the relationship between sleep and symptoms is cyclical; getting inadequate sleep can exacerbate bipolar symptoms, but bipolar symptoms can also make sleeping more difficult.
Do people with bipolar disorder and sleep problems stay in bed all day?
Mood disorders like bipolar disorder and major depressive disorder are known to go hand-in-hand with sleep disorders. Sleep problems and disturbed sleep patterns can not only exacerbate the symptoms of a mental health condition, but the mental health condition may also worsen the sleep disorder itself. A person with bipolar disorder might oscillate between getting too much sleep during a depressive episode and getting too little sleep during a manic episode.
Effects of sleep disturbances experienced by individuals with bipolar disorder
The sleep disturbances of bipolar could create conditions wherein a person struggles to get out of bed during the day. However, staying in bed all day is likely to occur during a depressive episode and does not represent the norm for a person with bipolar disorder. On the opposite extreme, they may find it challenging to remain in bed at all if they are working to manage a manic episode.
Do people with bipolar disorder sleep a lot?
People with bipolar disorder are known to have trouble getting adequate sleep. However, much of the concern surrounds insomnia and taking a long time to get to sleep. Poor sleep quality overall is also common, which can significantly worsen bipolar disorder symptoms. People with bipolar disorder usually find it challenging to control their circadian rhythm and may go to sleep much later than what is typical for others.
While much of the research focuses on the insomnia experienced by those with bipolar disorders, contemporary research has given more focus to the hypersomnia (excessive sleep) that commonly occurs during depressive episodes. Manic symptoms or hypomanic episodes are the main drivers of insomnia, while research suggests that hypersomnia is due to the lack of motivation and drive that is commonly found in major depression or other mental disorders.
What triggers bipolar disorder?
The mood swings characteristic of bipolar disorder can be managed by learning to recognize early signs of a mood change. Other triggers can also lead to an episode of bipolar disorder, but triggers tend to vary from person to person. Evidence indicates that improperly adjusted antidepressant medication can be a significant trigger for manic episodes, underscoring the importance of having medication managed by a healthcare professional skilled in treating bipolar disorder.
Other factors that might trigger manic episodes include caffeine intake, seasonal changes, hormonal imbalances, and infections. Common triggers for depressive episodes are fasting, sleep issues, and undergoing stressful situations. Additionally, there's evidence suggesting that traumatic brain injuries might trigger or worsen symptoms of bipolar disorder.
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