Colin Snow
Sleep disturbances are a common symptom of bipolar disorder, with up to 70% of bipolar patients reporting insomnia even when their mood is stable. Bipolar disorder acts like a sleep disorder, with sleep patterns often changing when a person is experiencing a manic episode or depression. Sleep management is the number one way a person with bipolar disorder can naturally and inexpensively manage their symptoms. While medications are available to help with sleep, they can be addictive and have side effects. Psychological interventions and therapies are often preferred by patients as they are low in side effects, durable, and have no abuse potential.
| Characteristics | Values |
|---|---|
| Sleep disturbances | Insomnia, hypersomnia, delayed sleep phase, irregular sleep-wake schedule, sleep apnea, sleep talking, sleepwalking, sleep phase delay syndrome |
| Causes | Bipolar disorder symptoms, medication side effects, substance use, caffeine, nicotine, bright light, exercise |
| Treatment | Circadian therapies (e.g. ramelteon, dark therapy, CBT-I), hypnotics, sedating antidepressants, melatonin, valerian root, bright light therapy, strict sleep schedule, sleep aids |
| Recommendations | Consistent sleep and wake times, comfortable bedroom, nutritious dinner, regular exercise, limit caffeine, nicotine and alcohol |
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What You'll Learn
Sleep-wake cycle interventions
Medication Approaches
Pharmacological treatments for bipolar disorder often address sleep disturbances as they are inseparable from the disorder. However, medications can also cause or worsen sleep issues as a side effect. It is essential to consult a doctor and carefully consider the types and timing of medications to minimise their impact on sleep. For example, taking medications that cause drowsiness at night instead of during the day can help. Additionally, sleep aids and medications like Ambien (zolpidem), Lunesta, and Sonata can be used short-term to aid sleep, but they should be used cautiously due to potential side effects and addiction risks.
Psychological Interventions
Psychological interventions, such as cognitive behavioural therapy for insomnia (CBT-I), are advantageous due to their low side effects, patient preference, durability, and lack of abuse potential. Circadian therapies like ramelteon, dark therapy, and CBT-I focus on retraining the circadian rhythm, offering more lasting benefits for mood and sleep compared to fast-acting hypnotics.
Light Therapies
Bright light therapy is often used to manage circadian rhythm disorders and normalise sleep patterns. Using a light box in the morning can increase serotonin levels, but it should be avoided by individuals with bipolar disorder as it may trigger mania.
Lifestyle Changes
Establishing a consistent sleep and wake-up schedule is crucial for maintaining the circadian rhythm and improving sleep quality. Additionally, creating a comfortable and quiet bedroom environment, maintaining a moderate temperature, and avoiding stimulants like caffeine and nicotine before bedtime can promote better sleep. Regular exercise is beneficial, but it should be done earlier in the day as exercising too close to bedtime can make it challenging to fall asleep.
Sleep Hygiene
Sleep hygiene practices include reserving the bedroom for sleeping and limiting activities like eating, watching TV, or working. A nutritious diet, avoiding alcohol and heavy meals close to bedtime, and prioritising a substantial dinner can also improve sleep. Winding down before bedtime with relaxing activities such as reading, journaling, or meditation can help prepare the body for sleep.
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Medication side effects
Bipolar disorder is a severe and chronic mental health condition. It is often life-threatening, with approximately 1 in 5 individuals completing suicide. Bipolar disorder acts like a sleep disorder, with sleep disturbances being characteristic of the condition. These disturbances include insomnia, hypersomnia, delayed sleep phase, irregular sleep-wake schedules, and reduced sleep need.
Sleep problems can be both a cause and an effect of bipolar disorder. Poor sleep can worsen bipolar symptoms, and bipolar symptoms can interfere with one's ability to sleep. Treating sleep problems can be a helpful first step in managing bipolar disorder symptoms. However, medications used to treat bipolar disorder may cause sleep issues as a side effect. They may also interact with other medications or supplements, causing further sleep problems.
Psychological interventions for sleep disturbances are advantageous as they are low in side effects, may be preferred by patients, are durable, and have no abuse potential. Circadian therapies like ramelteon, dark therapy, and CBT-insomnia promise more lasting and substantial benefits for mood and sleep than fast-acting hypnotics.
Some medications that can be used to aid sleep for those with bipolar disorder include:
- Zolpidem (Ambien)
- Eszopiclone (Lunesta)
- Zaleplon (Sonata)
However, these medications may have side effects and can be habit-forming. Ambien, for example, may cause unusual side effects such as sleepwalking, sleep eating, and even sleep driving. It may also lose its effectiveness if taken for longer than two weeks. Lunesta and Sonata may not be safe for those with a history of depression, mental illness, or suicidal thoughts.
It is important to consult a doctor before taking any sleep aids, as they can have adverse effects on coordination and cause sleepiness and even amnesia. Sleep aids should not be combined with alcohol or other substances.
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Psychological interventions
Sleep disturbances are a common symptom of bipolar disorder, with insomnia, hypersomnia, delayed sleep phase, irregular sleep-wake schedules, and reduced sleep needs all being characteristic of the disorder. Bipolar disorder is a severe and recurrent illness that affects an individual's functioning, and it is often life-threatening, with approximately 15-20% of individuals completing suicide. Therefore, it is important to address sleep issues in bipolar disorder to improve mood and reduce impairment.
One psychological intervention that has been shown to be promising in treating sleep disturbances in bipolar disorder is modified cognitive behavioural therapy (CBT). CBT can help individuals with bipolar disorder manage their sleep by teaching them techniques to regulate their sleep-wake cycles and improve their sleep hygiene. This may include strategies such as maintaining a consistent sleep schedule, creating a relaxing sleep environment, and avoiding stimulants like caffeine and nicotine before bed.
Another psychological intervention that has been suggested for bipolar disorder is light therapy. Bright light therapy can help manage circadian rhythm disorders and normalize sleep patterns. This involves exposure to bright light during the day or the use of a light box in the morning to increase serotonin levels. However, it is important to note that the use of light therapy without mood swing prevention is discouraged in bipolar disorder, as increasing serotonin levels can potentially induce mania.
Overall, psychological interventions for sleep disturbances in bipolar disorder offer a safe and effective approach that is well-tolerated by patients. By targeting sleep and circadian rhythms through interventions such as CBT and light therapy, individuals with bipolar disorder can improve their sleep and manage their mood symptoms more effectively.
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Light and dark therapies
Sleep problems are common in people with bipolar disorder, and these sleep issues can make the disorder even more difficult to manage. Bipolar disorder is characterised by insomnia, hypersomnia, delayed sleep phase, irregular sleep-wake schedules, and reduced sleep need.
Light therapy and dark therapy are two treatments that can be used to help manage bipolar disorder by manipulating the body's circadian rhythm.
Light Therapy
Bright light therapy involves using a light box with fluorescent bulbs that emit 7,000 to 10,000 lux of UV-filtered bright white light. The light box is placed on a table at eye level, and the patient sits in front of it for 30 minutes to two hours a day. Light therapy can also be administered through head-mounted units or light visors. Light therapy has been shown to have a significant antidepressant effect, and it can be used in combination with medications and psychotherapy. It is important to note that using bright light therapy in the evening may worsen insomnia.
Dark Therapy
Dark therapy, also known as virtual darkness therapy, involves blocking blue light in the evenings, usually with amber or orange-tinted glasses. This decrease in light can dampen manic symptoms. Dark therapy should not be used during the depressive phase, as it can provoke or worsen manic symptoms.
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Natural sleep aids
Sleep problems are common in people with bipolar disorder. Bipolar disorder is often accompanied by insomnia or hypersomnia. Even outside of episodes of depression, bipolar patients experience disturbed sleep. Poor sleep can worsen bipolar symptoms, and bipolar symptoms can interfere with your ability to sleep.
- Melatonin: This is a natural hormone released by the brain when it gets dark. It is available over the counter and comes in pills and spray forms. The recommended dose is 0.5 mg, 30 minutes to an hour before sleeping.
- Clonidine: This medication was originally used for high blood pressure but is also a good sleep aid. It is not habit-forming but can cause a drop in blood pressure or liver problems in high doses.
- Trazodone: This is an old-fashioned antidepressant that has become a popular sleep aid due to its sedating effects. However, it is limited to women due to the risk of priapism in men.
- Valerian: This is a natural sleep aid, but it may cause nightmares.
In addition to these natural sleep aids, there are several lifestyle changes that can improve sleep for people with bipolar disorder:
- Avoid caffeine and nicotine late in the day.
- Avoid energy drinks.
- Maintain a consistent sleep schedule by going to bed and waking up at the same time each day.
- Keep your bedroom quiet, dark, and at a comfortable temperature.
- Use blackout shades, earplugs, and a sleep mask to block out light and noise.
- Play calming background music as you drift off.
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Frequently asked questions
Some natural sleep aids that can be taken include melatonin supplements and valerian root. It is important to consult a doctor before taking any sleep aids.
Maintaining a consistent sleep schedule is beneficial for everyone, but especially for those with bipolar disorder. Other ways to improve sleep include avoiding caffeine and alcohol before bedtime, exercising earlier in the day, and keeping your bedroom quiet, dark, and at a comfortable temperature.
Some medications that can be used to aid sleep for bipolar disorder include Ambien, Lunesta, and Sonata. However, these medications may not be suitable for those with a history of mental illness or substance abuse. It is important to consult a doctor before taking any sleep medications.
Psychological interventions such as cognitive behavioral therapy for insomnia (CBT-I) can help improve sleep quality. Circadian therapies such as ramelteon, dark therapy, and CBT-I have been found to have lasting and substantial benefits for mood and sleep.
