Everyone can benefit from a good night’s sleep, but if you have bipolar disorder, a full night of rest can mean the difference between a stable mood and a manic episode. “The overwhelming majority of people with bipolar have sleep problems,” says Phillip Gehrman, PhD, a sleep specialist, an assistant professor in the department of psychiatry, and a member of the Penn Sleep Center at the University of Pennsylvania in Philadelphia. Changes in sleep — whether it’s sleeping too much with depression, battling insomnia, or experiencing sleeplessness with mania — are sometimes viewed as warning signs of oncoming bipolar episodes. However, many have wondered whether changes in sleep can trigger or worsen bipolar episodes as well. “Even between mood cycles, people with bipolar disorder may have sleep problems, and those sleep problems, if they persist, increase the risk of a relapse,” Dr. Gehrman says.
Experts such as Gehrman now believe that bipolar disorder interferes with a person’s circadian rhythm, the basic sleep-wake patterns that are set by glands in the brain and respond to changing light and dark as well as changing seasons. Research is starting to show that resetting this rhythm can ease bipolar symptoms and may reduce the risk for relapse or hospitalization.
In one study, researchers at the University of California, Berkeley, taught people with bipolar disorder struggling with insomnia to stick to a regular wake-up time as well as a set bedtime and found that their sleep improved. And for some, so did their bipolar symptoms. Reported in the July 2013 issue of the American Journal of Psychiatry, the findings came from a very small study, but if confirmed by additional research, they could have implications for a large number of people — the estimated 6 million adults, or nearly 3 percent of the U.S. adult population, that have bipolar disorder.
Bipolar Disorder and Sleep Disturbances
Sleep disturbances related to bipolar disorder run the gamut from sleeping too much to not feeling the need to sleep much at all.
As people with bipolar disorder sink into depression, they might face either extreme: Insomnia or sleeping too much — both of which are depression symptoms. On the other hand, people entering hypomania, or a full mania stage, might feel that they don’t need as much sleep as usual. Sleep changes, in fact, are so common that they’re considered early warning signs that a bipolar episode is on the way and that additional medical attention may be needed, Gehrman says.
Between cycles, people with bipolar disorder also report lower-quality sleep in general, with more night waking, a general sense of less sleep, and, occasional insomnia. It’s the lack of quality sleep that seems to put people with bipolar at risk for another episode, Gehrman says.
Medications for bipolar disorder can also affect sleep to some degree. For example, a potential side effect of antidepressants is that they make some people sleepier than normal. Some drugs are prescribed to help regulate sleep by helping the person sleep more. However, improving insomnia and poor-quality sleep usually requires more than medications; lifestyle changes and cognitive behavioral therapy may help. Although a doctor might supplement these strategies with a medication prescription, people with bipolar disorder should avoid trying over-the-counter sleep aids or self-medicating with alcohol, Gehrman says.
How to Get Better Sleep With Bipolar Disorder
Certain lifestyle changes can help combat sleep disturbances and improve your quality of sleep. In addition to following the treatment regimen recommended by your doctor, these sleep tips may help:
- Wake up at the same time every day. This is the most important technique to build a better sleep schedule with bipolar disorder, says Kyoung Bin Im, MD, a sleep specialist and clinical assistant professor of neurology and psychiatry at the University of Iowa’s Carver College of Medicine in Iowa City. “If you do nothing else to improve your sleep habits, wake up and get out of bed at the same time no matter what, no matter how much sleep you got the night before,” he says.
- Get early-morning light. About 30 minutes of light early in the day can kick-start your body’s sleep-wake cycle. After getting up at the same time each day, Dr. Im says getting either morning sunlight or full-spectrum light from a specialized light box is the second most important step you can take to reset the circadian disruption caused by bipolar disorder.
- Cut the caffeine. Don’t try to compensate for lack of sleep with coffee — that’s likely to make future sleep more difficult because caffeine can linger in your system for up to 10 hours. Switch to decaffeinated beverages in the afternoon and evening.
- Don’t smoke near bedtime. And if you can’t sleep, don’t get up and have a cigarette, thinking that it’ll relax you into sleep. This is a common habit among people with bipolar disorder. Nicotine is a stimulant, so stop smoking about two hours before going to bed and skip nicotine entirely if you find yourself waking up too early.
- Drink alcohol moderately, if at all. Gehrman says people with bipolar disorder are at risk for self-medicating with alcohol to cope, but it won’t help sleep. Alcohol might make you feel sleepy, but it actually results in poorer sleep quality, even if you go to sleep and stay asleep.
- Watch your weight. Some medications for bipolar disorder can lead to weight gain. But being overweight contributes to some sleep disorders, such as obstructive sleep apnea. To keep your weight in check, be sure to exercise regularly and eat a healthy diet.
- Talk to your doctor about trying melatonin. This is the hormone your body naturally produces to tell all systems that sleep is on the way. Taking over-the-counter melatonin about three hours before your desired bedtime may help you send that message. There’s no evidence that melatonin interacts with medications for bipolar disorder, Gehrman says, but it’s still wise to ask your doctor about it first.
- Limit light before bed. If possible, spend the hour or two before bed away from bright lights, sunlight (if you work nights and need to sleep during the day), and screens that emit blue light, which include laptops and cell phones.
- Get up if you can’t sleep. If bipolar disorder has you struggling with insomnia, get out of bed when you can’t sleep and do something soothing in low light. Then go back to bed when you’re tired, but get up on time in the morning anyway.
- Power-nap. If daytime sleepiness is interfering with your life, naps are fine as long as they’re brief, Gehrman says. Set an alarm for 30 minutes.
You may also consider setting up an appointment with a cognitive behavioral therapist trained in sleep management to help you find ways to create and stick to a healthy sleep schedule. Cognitive behavioral therapy can help you identify thoughts and behaviors that could be negatively affecting your sleep. A sleep medicine specialist might be helpful if you have reason to believe you have a sleep disorder in addition to bipolar disorder. Symptoms of a sleep disorder include loud snoring, excessive daytime sleepiness, or physical discomfort (like pain or restlessness) that leads to interrupted sleep.