In fact, the relationship between bipolar disorder and sleep issues is a two-way street — poor sleep can worsen symptoms of bipolar disorder, and bipolar symptoms can interfere with your ability to sleep, says Jennifer Martin, PhD, the president-elect of the board of directors for the American Academy of Sleep Medicine (AASM) and a professor of medicine at the David Geffen School of Medicine at the University of California in Los Angeles. Scientists haven’t yet pinpointed the connection between poor sleep and bipolar disorder. One theory is that people with this mood disorder may be genetically predisposed to sleep issues, which in turn may lead to abnormal shifts in their body’s internal sleep clock, according to a review from February 2016 in Nature and Science of Sleep.
People With Bipolar Disorder Are Prone to Sleep Problems
Being mindful and protective of your sleep cycle is vital if you’ve been diagnosed with bipolar disorder. This is true even if you’re feeling stable and functioning well without symptoms. The reason: 80 percent of people whose bipolar disorder is in remission have sleep problems, which can lead to mood relapses, according to a review published in August 2017 in L’Encéphale. “Even if someone makes do on little sleep, it can have repercussions, such as increased moodiness, depression, worry, difficulty concentrating, and even higher risk for accidental death in a worst-case scenario,” explains Sanam Hafeez, PsyD, a licensed psychologist in New York City and the director of Comprehensive Consultation Psychological Services, a center for neuropsychological, psychiatric, and educational difficulties. So, if you’re having sleep issues, tell your doctor as soon as possible, advises Gonzalo Laje, MD, the director of Washington Behavioral Medicine Associates in Chevy Chase, Maryland.
Bipolar Disorder Can Make You Feel Like You Don’t Need Sleep
The sleep issues that people with bipolar disorder experience can vary. For example, some individuals may find they need less sleep, while others may find they can’t get enough sleep, per the American Psychiatric Association. If you are experiencing the highs of bipolar disorder (mania), you may suddenly need dramatically fewer hours of sleep to stay alert and energized. For example, someone who regularly sleeps eight hours may feel rested on only four hours of sleep. This is because mania can be so exciting or stimulating that you don’t feel tired even while running on significantly less sleep than normal, explains Dr. Hafeez. “Difficulties falling asleep, on the other hand, are events more likely to happen when patients are undergoing a depressive episode [or the lows of bipolar disorder],” explains Dr. Laje. “For example, some patients try to sleep but can’t fall asleep, or they have disrupted sleep such as waking up in the middle of the night and not being able to go back to sleep or waking up too early.” Here are some sleep problems common among people with bipolar disorder, according to the review in L’Encéphale.
Insomnia is marked by difficulty falling asleep, staying asleep throughout the night, waking up too early in the morning, or a combination of these.Obstructive sleep apnea causes a person’s breathing to become shallow or very briefly stop altogether while they’re asleep, often leading to chronic daytime sleepiness.Restless legs syndrome is characterized by an overwhelming urge to move the legs, often disrupting sleep.Sleep phase delay syndrome causes an individual to have trouble falling asleep, resulting in sleep that’s delayed by at least two hours beyond what’s viewed as an acceptable bedtime, per Stanford University School of Medicine.
Lack of Sleep Can Trigger Bipolar Symptoms
In the same way that bipolar disorder can cause sleep issues, the reverse can also be true: Lack of sleep can exacerbate symptoms of bipolar disorder. In fact, for many with bipolar disorder, sleep issues are the most common cue that a manic episode is looming, says Hafeez. According to a study published in September 2017 in the British Journal of Psychiatry, which included more than 3,100 people with bipolar disorder, sleep loss was found to trigger high mood episodes (mania), especially among women and those with bipolar I disorder. One situation that the authors noted could predispose someone to high mood episodes was shift work. And Hafeez points out two others: “Jet lag as well as sleep deprivation can trigger hypomanic or manic periods for some with this disorder.”
6 Expert-Backed Recommendations for Better Sleep
Getting manic symptoms under control usually curbs a decreased need for sleep, and consistently getting enough sleep can help reduce the risk of future manic episodes. Similarly, breaking free of oversleeping can be an important step toward remission from bipolar-related depression. But even when a sleep disorder occurs concurrently with bipolar disorder, it remains a separate health condition that may require specific treatment by a medical professional. That said, steps to improve your sleep can’t hurt and will likely help you better manage both bipolar disorder and any sleep disorder you may have.
1. Seek Professional Help
As with all mood disorders, treatment by a mental health professional can improve your symptoms, including sleep issues, says Dr. Martin. You might also schedule an appointment with a doctor at an accredited sleep disorders center near you. “There are many board-certified sleep medicine physicians who are neurologists and psychiatrists who may be especially well-suited to help,” Martin says. Organizations like AASM have search tools to help you find a sleep center near you. “In addition, if people with bipolar disorder struggle with insomnia even when their mood symptoms are stable, they can still benefit from direct treatment of insomnia by a behavioral sleep medicine specialist, like a clinical sleep psychologist,” Martin says. Cognitive behavioral therapy — which focuses on changing unhelpful thinking and behavior patterns into healthier ones — is commonly used to treat insomnia and can be safely adapted for people with bipolar disorder, she says.
2. Ask Your Doctor for Sleep-Friendly Tweaks to Your Bipolar Medications
Medications used to treat bipolar disorder may cause sleep issues as a side effect, Martin says. They may also interact with other medications or supplements you’re using and cause your sleep problems. Ask your doctor if you should take your medications at specific times of day to minimize their impact on your sleep. For instance, Martin says, you could take medications that make you feel drowsy at night rather than during the day. Sometimes adjustments to the types or doses of medication can help — but always talk to your doctor before making any changes to your medication regimen to avoid worsening your bipolar symptoms.
3. Set a Bedtime Schedule and Make It Nonnegotiable
Going to bed at the same time each night and waking up at the same time each morning as consistently as possible will strengthen your circadian rhythm, the internal clock that regulates your sleep-wake cycle. This, in turn, will improve your shot at a good night’s rest and reduce your risk for mood episodes down the road, says Martin. “People with bipolar disorder should be particularly careful to avoid periods of sleep deprivation, as this is one factor that can contribute to mania,” she says.
4. Keep a Sleep Diary
Keep track of your sleep habits and symptoms over time so you and your doctor can detect patterns that may be militating against your good night’s sleep. Hafeez suggests using the diary each morning to jot down:
How long it took you to fall asleep the previous nightHow many times you woke up during the nightHow long you stayed asleepAny medications you took to help you sleepWhether you had caffeine or alcohol prior to bedtimeWhether you exercised during the day, what time you exercised, and for how long
5. Steer Clear of Stimulating Activities or Substances Near Bedtime
Use the last hour or two before bedtime to prepare your body for sleep. This means avoiding bright lights, cellphones, and stimulating activities, says Hafeez. And before you turn in for the night, “place your cellphone facedown so the light is not emitted from it,” she says. Although regular exercise is helpful for managing bipolar symptoms, exercising too close to bedtime can be stimulating and make it difficult for you to fall asleep, she adds. To avoid this, exercise earlier in the day. To prepare your body for bedtime, Hafeez suggests that you:
Avoid caffeine and alcohol late in the day.Keep your bedroom as quiet and dark as possible.Maintain a room temperature that’s not too cold or hot. According to the Sleep Foundation, a bedroom temperature of 60 to 67 degrees F can deepen sleep.Use black-out shades, earplugs, and a sleep mask to block excessive light and noise.Play calming background music as you drift off. (To find free tracks, type the keywords “calming music for sleep” in Google or another search engine.)Nicotine is a stimulant, so if you smoke cigarettes, avoid doing so in the last two hours before you sleep.
6. Try Bright Light Therapy in the Morning
Bright light therapy is often used to manage circadian rhythm disorders and can gradually normalize your sleep patterns, according to Stanford University School of Medicine. While bright light therapy can be helpful for nearly anyone with sleep issues, a 2017 research review published in the Einstein Journal of Biology and Medicine found it may be especially helpful for people with bipolar disorder when combined with usual treatments. To get the most out of bright light therapy, experts at Stanford University School of Medicine suggest you use the device as soon as possible after you wake up in the morning. There are many bright light therapy devices available to purchase. Ask your doctor to recommend the best one for you.
