Sleep Management In Bipolar Disorder: Manage Sleep-Related Symptoms For Better Health

Sleep difficulties tend to be a hallmark of bipolar disorder. They may appear during both manic and depressive episodes, and some people may continue to experience them during periods of remission. 

Research has shown that sleep disturbances may be more than a symptom of bipolar disorder; they may also be a contributing factor to the condition. Medication, sleep hygiene practices, lifestyle changes, and therapy may be helpful in improving the sleep habits of those living with bipolar disorder. 

Sleep management can be vital for people with bipolar disorder

Talk to an online therapist to learn more

What is bipolar disorder?

Bipolar disorder is a mood disorder typically characterized by shifts in mood between mania and depression. Symptoms can vary from person to person. Some people may cycle between these two extremes rapidly, while others may have extended periods without symptoms. 

Periods of depression experienced by many people with bipolar disorder can be debilitating, often affecting their ability to function. These individuals may experience an intense sense of loss, guilt, or failure. Both depressive and manic episodes can increase the risk of suicidal thoughts.

What qualifies someone for a diagnosis?

In general, to be diagnosed with bipolar disorder, a person must have at least one episode of mania or hypomania. Someone experiencing a manic episode may feel excited, energized, invincible, and productive. They may prefer the way they feel during a manic episode, especially when contrasted with the way they feel during a period of depression, but manic episodes can sometimes lead to reckless, unpredictable behavior and unnecessary risks. 

Hypomania can be seen as a milder form of mania that may present as an elevated mood or change in activity level that is significant enough to be noticed by others. It generally does not affect a person’s ability to function in everyday life.  

Sleep patterns and bipolar disorder

Research shows that sleep disturbances can be highly prevalent among people with bipolar disorder and “exert a detrimental impact on the course of illness, self-reported quality of life, functioning, symptom burden, and overall treatment outcomes.”

Sleep disturbances tend to occur across all stages of bipolar disorder, including manic, depressive, and mixed episodes, and during periods of symptom remission. That said, they often manifest differently depending on the stage. 

Sleep during mania

During mania or hypomania, people with bipolar disorder typically report having a lessened need for sleep or difficulties falling or staying asleep. Studies have found that people in the manic stage of bipolar disorder usually have a shorter total sleep time and a greater awake time in bed. 

Being unable to sleep or sensing that they don’t require sleep is usually a byproduct of hyperactivity, rather than a legitimate decreased need for sleep. This reduction in sleep can be an important factor leading up to a manic episode.

Sleep during depression

Sleep during periods of symptom remission

For some people, sleep disruptions can continue between bipolar episodes. This time between episodes is usually called “euthymia.” Studies have found that about 70% of people with bipolar disorder continue to experience sleep disturbances during euthymia. 

Research suggests that these individuals spend more time in bed and demonstrate longer periods of sleep. They may also have significant variability in total sleep time, wake up more frequently at night, and take longer to fall asleep.

How sleep management and bipolar disorder are linked

Researchers aren’t sure why sleep seems to be at the root of bipolar disorder, but they do have some theories. A widely accepted explanation is that sleep disturbances in bipolar disorder may be linked to dysregulated circadian rhythms. 

Circadian rhythms can be defined as the processes that maintain the body’s 24-hour cycle. They typically include a range of factors, including body temperature regulation, hormone secretion, feeding activity, mood, and sleep-wake rhythm.

Circadian rhythms and melatonin levels may affect how someone manages sleep

Some research indicates that those with bipolar disorder may have weak circadian rhythms, which may contribute to their manic and depressive episodes. One explanation for why this might occur is that people with bipolar disorder may have an abnormal release of melatonin. 

Melatonin is a hormone that typically helps manage the sleep/wake cycle in relation to light cues in the environment. Some studies have found that people with bipolar disorder have increased melatonin during mania and decreased melatonin during depression.

While more research is likely needed, some psychologists theorize that improving sleep in people who are predisposed to bipolar disorder may be an approach to early intervention, particularly as sleep is “easy to assess, modifiable, and largely free of social stigmatization.”

Interventions to manage sleep in bipolar disorder

Many interventions may help people manage the sleep disturbances that occur with bipolar disorder.

Medication

Medications used to treat bipolar disorder, like mood stabilizers or antipsychotics, may regulate sleep in people with the disorder. These medications must be prescribed by a doctor or psychiatrist, and it can be crucial to talk to your prescribing provider before starting, stopping, or changing the way you take medication.

Sleep management/hygiene

Establishing a regular sleep schedule and limiting exposure to light can also improve sleep. An effective sleep routine may include reserving the bed only for sleep, creating a regular routine for winding down before bed, and getting out of bed when you can’t sleep.

Lifestyle modifications

Waking up at the same time every day can help individuals maintain a consistent sleep schedule. People who have a difficult time sleeping may also try limiting their alcohol and caffeine intake, avoiding naps, exercising regularly, and limiting screen time before bed.

Psychotherapy

Talk therapy, specifically cognitive behavioral therapy (CBT), can help people with insomnia, but more research is needed regarding whether CBT can help people with insomnia due to bipolar disorder. 

Some researchers theorize that modified CBT may help. Therapy sessions may focus on what leads to insomnia and the sleep-related consequences and behaviors the person experiences throughout the day. Therapists may also educate people with this condition about the circadian rhythm and the factors that can influence it.

Psychotherapy can also help people with bipolar disorder learn to manage its symptoms, as well as the symptoms of any co-occurring mental health conditions, like anxiety, ADHD, or substance use disorders. Symptom management can promote better sleep. 

Therapy can benefit loved ones, too

Therapy can also be beneficial for loved ones of those with bipolar disorder. If someone you love is experiencing symptoms of bipolar disorder, working with a mental health professional can help you understand more about their symptoms and what you can do to help. If you are experiencing stress or anxiety due to your loved one’s diagnosis, therapy can help you cope.

Online therapy as an alternative

Online therapy can be an effective treatment option for people with bipolar disorder and their loved ones. With an online therapy platform like BetterHelp, you can attend sessions with a licensed therapist at a time that fits your schedule from anywhere with an internet connection. 

In addition to being flexible and convenient, research shows that online therapy can be effective. A 2017 study found that online cognitive behavioral therapy could be effective in the treatment of various mental health conditions, including bipolar disorder, anxiety, depression, and substance use disorders.