Bipolar Disorder and Sleep Problems

Are you tossing and turning at night, unable to get to sleep? It could be related to your bipolar disorder.


If you have bipolar disorder, keeping to a regular sleep routine is crucial to keeping moods in check. But people with this disorder often have insomnia or other sleep issues. In fact, the relationship between sleep and bipolar disorder is very complex, says Ellen Frank, PhD, distinguished professor of psychiatry and professor of psychology at the University of Pittsburgh School of Medicine’s Western Psychiatric Institute, and one of the country’s leading researchers in this area of study. “Restless sleep when you have bipolar disorder can mean two very different things,” explains Dr. Frank. “One, it can signal that an episode of mania or depression is coming. Or two, it can mean something external disturbed your usual sleep pattern. In that case, the sleep problem — even one night of missed sleep — can trigger a mania episode that might not have otherwise happened.” What’s more, says Frank, when manic symptoms occur as a result of poor sleep, you may begin to believe that you don’t need to take your medications — which will likely have serious consequences.

Bipolar Disorder and Sleep Problems: What’s the Connection?

Each body organ — from kidneys to muscles — has a gene that puts it on an internal 24-hour clock. These are called circadian genes, and the sleep-wake patterns, or rhythms, they produce are known as endogenous rhythms because they are produced within the body. However, as Frank explains, the sleep-wake cycle is also influenced by exogenous rhythms outside the body — such as the rising and setting of the sun, or mealtimes. “For instance,” Frank says, “if my plane lands in Italy at seven a.m. and my gut’s still on Pittsburgh time, where it’s the middle of the night, I won’t want to eat. But once I see sunshine, smell food cooking, and put something in my stomach, my organs will wake up: ‘Hello! Something different is going on here.'” In people with bipolar disorder, both exogenous and endogenous rhythms are much more sensitive than in people without this condition, says Frank, which makes them prone to sleep disturbances.

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Bipolar Disorder: Getting a Good Night’s Rest

So how can people with bipolar disorder get the sleep they need? Frank suggests the following:

Track your daily patterns. Filling out a daily form called a “Social Rhythm Metric” can help identify your daily sleep-wake patterns as well as other regular activities, and also track how your mood corresponds to each. “It takes two minutes a day. You record when you got up, when you first had contact with another person, when you started work or school, when you had dinner, and when you went to bed,” says Frank. By using the form over several weeks or months, you can figure out which bedtimes and wake times correspond to your best mood state.

Look out for zeitstorers! The German words “zeitgeber” (time-giver) and “zeitstorer” (time-taker) are used by researchers to describe different cues in your environment that can affect your schedule. A zeitgeber, says Frank, is an event or person that helps you maintain your routine — for example, a cat that should be let out at a given time or a spouse who must catch the same train daily. A zeitstorer, conversely, disturbs your routine, the way a business trip or overnight guests might. Figuring out how to maximize the use of zeitgebers and minimize the effect of zeitstorers will ultimately help improve your sleep and mental health.

Try IPSRT. Interpersonal and social rhythm therapy (IPSRT), developed by Frank and colleagues about 20 years ago, helps you understand the importance of regularity in your daily routines, especially how a consistent sleep/wake cycle can stabilize your mood and help to prevent new episodes of illness. “You learn to anticipate changes in routine, such as a vacation or a time when your spouse will be away, and how to maintain — as closely as possible — your usual sleep patterns in spite of these changes. You also learn how to carefully adhere to your usual medication regimen,” says Frank.

Accept the situation and work with it. “This problem isn’t going away,” says Frank. Just because your spouse can choose to go to bed at eight p.m. one night and one a.m. the next and suffer no ill effects, you can’t. You must make your sleep routine a priority of the household.

Like a Finely Tuned Watch

Frank sympathizes with how difficult it can be for people with bipolar disorder to regulate their sleep and other activity routines. “But I like to use an old TV commercial for Timex watches as an analogy,” Frank says. “A Timex was thrown off the top of the Empire State Building, and when it hit the ground, it was still ticking. Well, you wouldn’t get the same result if you threw a Piaget watch off the top of that building. It’s an exquisitely sensitive instrument. And that’s what we tell our patients: You aren’t a Timex. You’re a Piaget.”

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