Bipolar disorder and sleep problems

Changes in sleep that last for more than two weeks or interfere with your life can point to an underlying condition, and of course many things may contribute to sleep problems. However, for people with bipolar disorder there are connections between the disorder and sleep. Here’s what you can do to improve your sleep.

How bipolar disorder affects sleep

Bipolar disorder may affect sleep in many ways. For example it can lead to:

• Insomnia, the inability to fall asleep or remain asleep long enough to feel rested.
• Delayed sleep phase syndrome, a circadian-rhythm sleep disorder resulting in insomnia and daytime sleepiness.
• REM (rapid eye movement) sleep abnormalities, which may make dreams very vivid or bizarre.
• Irregular sleep-wake schedules, which sometimes results from a lifestyle that involves medication-seeking behaviour at night.

During the lows of bipolar disorder, you may have overwhelming feelings of hopelessness, sadness and worthlessness. These can interfere with your sleep.

During the highs of bipolar disorder (periods of mania), you may be so aroused that you can go for days without sleep. For three in four people with bipolar disorder, sleep problems are the most common signal that a period of mania is about to occur.

When sleep is in short supply, someone with bipolar disorder may not miss it the way other people would. However, even though you seem to get by on so little sleep, lack of sleep can take quite a toll. For example you may:

• Be extremely moody
• Feel sick, tired, depressed or worried
• Have trouble concentrating or making decisions
• Be at higher risk of an accidental death

You may already know that the ups and downs of bipolar disorder affect sleep. However, even between acute episodes of bipolar disorder, sleep may still be affected. You may have:

• Heightened anxiety
• Worries about not sleeping well
• Sluggishness during the day
• A tendency to have misperceptions about sleep

Get better sleep with bipolar disorder

Disrupted sleep can really aggravate a mood disorder. A first step might involve figuring out all the factors that may be affecting sleep and discussing them with the doctor. Keeping a sleep diary may help. Include information about:

• How long it takes to go to sleep
• How many times you wake up during the night
• How long you sleep all night
• When you take medication or use caffeine, alcohol or nicotine
• When you exercise and for how long

Certain bipolar medications may also affect sleep as a side effect. For example, they may disrupt the sleep-wake cycle. One way to address this is to move bedtime and waking time later and later each day until you reach your desired goal. Another way to handle this situation is with bright light therapy.

Of course your doctor may recommend a change in medication if needed. Be sure to discuss any other medicines or medical conditions that may be affecting your sleep, such as arthritis, migraines or a back injury.

Restoring a regular schedule of daily activities and sleep - perhaps with the help of cognitive behavioural therapy - can go a long way towards helping restore more even moods.

Steps like these may also help restore sleep:

• Eliminate alcohol and caffeine late in the day.
• Keep the bedroom as dark and quiet as possible and maintain a temperature that is not too hot or cold. Use fans, heaters, blinds, earplugs or sleep masks as needed.
• Talk with your partner about ways to minimise snoring or other sleep habits that may be affecting your sleep.
• Exercise, but not too late in the day.
• Try visualisation and other relaxation techniques.