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Bipolar Disorder & Sleep Issues: What You Should Know

Bipolar disorder may lead to issues like insomnia or hypersomnia. Learn about the link between sleep and bipolar disorder and find treatment options. Bipolar disorder is a mental health condition characterized by fluctuations in mood. A person with bipolar disorder can experience euphoric highs and devastating lows. In up to 80% of cases, bipolar disorder can negatively impact sleep. It may even

  • Posted on 19th May, 2022 19:05 PM
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Bipolar disorder is a mental health condition characterized by fluctuations in mood. A person with bipolar disorder can experience euphoric highs and devastating lows. In up to 80% of cases, bipolar disorder can negatively impact sleep. It may even be triggered by sleep issues in some cases.

This article discusses the connection between bipolar disorder and various sleep issues, as well as prevention and treatment. 

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What Is Bipolar Disorder?

Bipolar disorder is a mood disorder characterized by changes in mood and energy.

While what causes bipolar disorder is not entirely known, research shows that there may be a hereditary component. People with a history of bipolar disorder in their family have an increased likelihood of developing the condition.

Other factors that have been linked to the onset of bipolar disorder include stressful life events, high or low levels of brain chemicals such as dopamine, serotonin, and norepinephrine, and sleep problems.

People with bipolar disorder will experience extreme mood changes, with periods referred to as mania or hypomania (a milder version of mania) and depressive states.

During a hypomanic or manic episode, people living with bipolar disorder may:

  • Feel an inflated sense of self-esteem
  • Talk excessively
  • Engage in risky activities that could have harmful consequences
  • Loss of appetite
  • Have racing thoughts
  • Be irritable
  • Feel a decreased need for sleep

Depressive states may include:

  • Loss of interest in activities
  • Low energy or lethargy
  • Trouble concentrating
  • Increased appetite
  • Sleeping too much
  • Have suicidal thoughts or thoughts about death

Help Is Available

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 800-273-8255 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911. For more mental health resources, see our National Helpline Database.

The Link Between Bipolar Disorder and Sleep

Sleep problems are common among people living with bipolar disorder. Disturbances to a person’s sleep schedule can impact their quality of life, daily functioning, and the course of their bipolar disorder. 

Sleep patterns play a significant role in bipolar disorder. A study examining the role of sleep with bipolar disorder identified mania and hypomania as causing a decreased need for sleep and noted people experiencing these states may have trouble falling asleep and staying asleep. The same study named hypersomnia as a common problem among people going through a depressive episode.

Problems with sleep are attributed to problems with a person’s circadian rhythm, or sleep-wake cycle. The circadian rhythm helps regulate important body processes such as temperature, hormones, mood, and sleep. When a person’s sleep-wake cycle becomes unregulated, they can experience an increased or decreased need for sleep, which can affect mood.

Risk Factors for Bipolar Disorder

Researchers are still exploring factors that increase a person’s likelihood of developing bipolar disorder. A 2018 study noted that approximately 2.4% of the population will experience a condition on the bipolar disorder spectrum in their lifetime. The same study provided the following risk factors:

  • Genetics (individuals with a first-degree relative experiencing bipolar disorder have a higher chance of developing the condition)
  • Traumatic events or abuse during childhood
  • Stressful life events (e.g., marital changes, disability, or job loss) 
  • Substance use

Sleep Issues Linked to Bipolar Disorder

Sleep problems can occur with any type of mood episode, which can make regulating sleep difficult. Various sleep problems are associated with bipolar disorder, including nightmares, trouble falling or staying asleep, sleep apnea (when breathing repeatedly stops and restarts throughout the night), poor quality sleep, and more.

Insomnia

Insomnia is a sleep disorder that can lead to poorer health outcomes for people with bipolar disorder.

Lack of or inability to sleep is an important sign of an impending manic episode. However, while people most often associate insomnia with mania, a person in a depressive state can have trouble sleeping. 

Hypersomnia

Also known as excessive sleepiness, hypersomnia is common among people with bipolar disorder. A study reported that up to 78% of people with bipolar disorder experience hypersomnia.

Decreased Need for Sleep

Mania and hypomania are linked to a decreased need for sleep. Lack of sleep can also trigger mania.

A decreased need for sleep is also a diagnostic criterion for a manic episode in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association's manual for diagnosing mental health conditions.

Delayed Sleep Phase Syndrome

Delayed sleep phase syndrome is caused by disturbances to your sleep-wake cycle and can cause extreme tiredness during the daytime.

REM Sleep Abnormalities

Rapid eye movement (REM) sleep plays a key role in brain functions, such as memory and dreaming.

People experiencing depression related to bipolar disorder may have disruptions to REM sleep, the period during sleep when brain activity increases. It may take them longer to fall asleep, reach a level of deep sleep, cause them to wake up more often, or have nightmares.

Irregular Sleep Schedules

Irregular sleep schedules can cause tiredness. People with bipolar disorder are encouraged to choose a set time each day to go to sleep and wake up. This helps regulate their body's circadian rhythm.

Sleep Apnea

Many individuals with bipolar disorder also have sleep apnea, a serious condition in which breathing is interrupted. This can lead to sleepiness and not feeling well-rested.

Side Effects of Disrupted Sleep

Disrupted sleep can contribute to issues at home, work, school, and in a person’s relationships. For people with bipolar disorder, sleeping less than 6.5 hours per night can lead to more serious symptoms.

Side effects of disrupted sleep can include:

  • Trouble falling asleep
  • Difficulty staying asleep
  • Excessive tiredness 
  • Not feeling rested
  • Problems with cognition and memory
  • Emotional distress
  • Difficulty performing tasks
  • Increased stress
  • Somatic problems, such as headaches and gastrointestinal issues

Treatment

Treatment for bipolar disorder often involves a combination of medication and psychotherapy.

Interpersonal and social rhythm therapy, family therapy, psychoeducation about bipolar disorder, and cognitive behavioral therapy (CBT) have been shown to help people identify triggers, develop balanced thinking, problem-solve, and brainstorm ways to cope with mood changes.

A healthcare provider may prescribe medications such as mood stabilizers or antipsychotics. Antidepressants may or may not be used with bipolar disorder, as they can sometimes trigger mania.

A healthcare provider may also prescribe medication to help you get better sleep. Talking with your provider about your symptoms is the best way to determine what treatment options may be right for you. 

Behavioral interventions can help improve sleep, including:

  • Reserving the bed solely for sleep
  • Establishing and maintaining a set sleep schedule seven days per week
  • Creating a wind-down routine to help promote relaxation and sleep
  • Limiting exposure to light, including from screens, close to sleep times
  • Monitoring sleep can aid with rest

When to See a Healthcare Provider

You may consider reaching out to a healthcare provider about your sleeping habits if you are noticing:

  • Increased sleepiness
  • Difficulty falling asleep and staying asleep
  • Decreased need for sleep
  • Shifts in mood
  • Issues with daily functioning

Prevention

Making lifestyle changes to support sleeping patterns can help you prevent sleep issues. Some tips to keep sleep issues at bay include:

  • Limit your intake of drugs and alcohol.
  • Consume less caffeine.
  • Keep a consistent sleep schedule by getting up at the same time every day. 
  • Limit your exposure to light and screen time before bed.
  • Avoid naps, especially closer to bedtime.
  • Designate your bed as a place for sleep.
  • Get out of bed if you aren’t able to sleep.
  • Gently expose yourself to light during the daytime.

Summary

Sleep plays a major role in bipolar disorder. Too much or too little sleep can disturb a person’s sleep-wake cycle and cause shifts in mood.

Various sleep problems are associated with bipolar disorder and these often lead to worse health outcomes for people with the condition. Keeping a consistent sleep schedule and seeking treatment for bipolar disorder and sleep issues can help an individual improve their patterns and mood.

A Word From Verywell

If you live with bipolar disorder, you know that getting restful and consistent sleep can be a challenge. Monitoring your sleep habits and identifying patterns or issues related to sleep can give you insights to share with your healthcare provider. Working with your provider to find ways to improve your sleep can help you feel more in control of managing your moods.

Frequently Asked Questions

  • How many hours should someone with bipolar disorder sleep?

    People living with bipolar disorder should aim to get the recommended amount of sleep for their age. The Centers for Disease Control and Prevention (CDC) recommends more than seven hours per night for adults. However, what's most important is sticking to a consistent sleep schedule. This helps with regulating a person’s sleep-wake cycle.

  • Can bipolar disorder affect your sleep?

    Yes, bipolar disorder can cause significant changes to sleep patterns. For instance, there is a decreased need for sleep with mania, which can cause a person to skip rest. With depressive episodes, people may find they are sleeping much more or much less than usual. Bipolar disorder can make it difficult to get on and stay on a sleep schedule, but a routine is essential to improving mood and reducing symptoms.

  • Will insomnia go away over time?

    Yes, it can. Insomnia also can be treated. To improve sleep, it's important to identify what is disrupting it. If bipolar disorder is at the root of the issue, you can work with your provider to identify triggers and discuss behavioral and pharmacological interventions that promote sleep.

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