It is estimated that over 4.4% of adults in America get diagnosed with bipolar disorder at some point in their life, which is a higher incidence rate than one might initially assume. The symptoms of this disorder are more extreme and wide-ranging than those in ADHD, causing even bigger oscillations in moods and higher incidence rates of substance abuse and problematic behavior. Despite this, bipolar disorder is often difficult to diagnose, passing under the radar because people dismiss the symptoms or attribute them to another condition. There are a few possible reasons for this. One might be that the manic episodes, unless severe and involving psychosis, usually feel good while they last, so people might not think to report them as a sign of something being wrong.
On the other hand, the depressive episodes in bipolar people might simply be mistaken for clinical depression. Finally, sleep deprivation is known to cause many of the symptoms related to bipolar disorder, like irritability, hyperactivity, mood swings and even depression, to name a few. Sleep disorders cover a vast array of symptoms on their own.
In reality, disturbed sleep is a core symptom of bipolar disorder. It is no surprise, seeing as how mania and depression both negatively affect it. Sleep disorders often go hand in hand with bipolar disorder, and make its symptoms even worse – but more about that later. First, let’s cover some ground on this specific disorder.
What is a Bipolar Disorder?
Bipolar disorder, also known as manic-depression illness, is a mental health disorder consisting of extended periods of extreme peaks (mania) and ebbs (depression) in a person’s mood and energy levels, with normal periods in-between. Contrary to popular opinion, this doesn’t refer to being emotional or having mood swings during a single day. People with bipolar disorder experience several days of long highs, known as manias, and several days of long depressive episodes. These can happen in a few different ways, don’t necessarily follow one another and can have a neutral state in between.
Bipolar disorder occurs in one’s adolescent or early adult years, often causing poor performance at school, work, and severely disrupting virtually all other aspects in one’s life (and the lives of those around them). Even so, many people suffer it needlessly for years without the appropriate diagnosis and treatment.
The cause of bipolar disorder is unknown. It has been shown to have a familial tendency, but the exact link hasn’t been discovered. The current consensus among psychiatrists is that a traumatic event triggers bipolar disorder to occur in a genetically predisposed individual.
Although bipolar disorder cannot be cured, it can be treated. With enough support and a good therapy plan, people with bipolar disorder can live fulfilling lives, have good careers and cultivate relationships.
Bipolar disorder symptoms are split into two categories: mania and depression symptoms.
Mania symptoms can last over three months if not timely treated. They include:
- Extreme, euphoric feelings. In a manic episode, this extreme high is unphased by one’s sad experiences or even tragic news
- Extreme restlessness. Extreme amounts of energy, inability to slow down or sit calmly
- Racing thoughts and inability to speak at a normal pace
- Diminished need for sleep. Going days on end with minimum to no sleep without feeling exhausted or even slightly tired, frequently resulting in insomnia
- Feeling very excited
- Extreme self-confidence. Feeling “on top of the world” with unrealistic assurance in own abilities; planning ambitious, overly-optimistic projects and feeling all-powerful
- High irritability and sometimes aggression
- Being easily distracted, poor focus
- Poor judgment. Acting impulsive and noticeably out of character
- Substance abuse and increased sexual activity
A manic episode is characterized by at least three of these symptoms (frequently including psychosis) happening at the same time and lasting for at least a week. During this time, behavior patterns are not only noticeably out of character, but functioning in usual environments like home or work is almost impossible. The symptoms are so severe that the person might get hospitalized to prevent serious self-harming or harming others around them.
When at least three of the listed symptoms occur together for a minimum of four days, but without the presence of psychosis, the episode is called hypomania. This term signifies a less severe and shorter lasting episode, with some noticeable impairment of the usual functioning but not to the extent as with mania. Hospitalization isn’t required as the person experiencing hypomania isn’t nearly as dangerous for self or others as one often is in a manic episode.
After a manic or hypomanic episode, one often feels ashamed of how they behaved and remembers little to none of what happened during the episode. These people may suddenly feel the burden of the responsibilities they signed up for, or promises they made during the manic episode that now don’t seem realistic or achievable.
- Persistent hopelessness or guilt
- Anxious or even suicidal thoughts
- Changes in meal patterns – eating less or more than usual, fluctuating weight
- Reduced energy, lethargia
- Daytime sleepiness and fatigue
- Changed sleep pattern – hypersomnia or insomnia
- Poor memory, inability to concentrate or finish simple tasks
A depressive episode might occur right after a manic episode, due to the sobering effect of the mania ending and the realization of how one behaved. Many people find depressive episodes more difficult to handle than manic or hypomanic episodes. It is probably because of the contrast between them; after a week-long period of euphoria, depression can seem that much more miserable. Depressive episodes can also occur after a neutral period.
A mixed episode is a term referring to an episode that features symptoms from both mania and depression lists and often carries a heightened suicide risk.
Types of bipolar disorder
Based on how frequently the episodes occur, and the nature of their symptoms, bipolar disorder is often split into four main types:
- Bipolar I disorder. To be diagnosed with this type of disorder, one has to have experienced at least a single manic episode. Although frequently accompanied by hypomanic and depressive episodes, a person diagnosed with bipolar I disorder may only ever experience manic episodes.
- Bipolar II disorder. This type of bipolar disorder describes a person who had at least one major episode of depression, and one of hypomania. People with this diagnosis often experience longer depressive episodes compared to people diagnosed with bipolar I disorder.
- Cyclothymic disorder. Much like the one before, this disorder includes depressive and hypomanic episodes, but to fall into this category, they have to occur on a fairly regular basis. The symptoms in these episodes are less severe than with the first two types of bipolar disorder, but their sheer frequency poses a problem in a person’s life.
- Rapid cycling refers to a disorder where one experiences at least four, and often more episodes of either mania, hypomania or depression within the time frame of a year.
Treating Bipolar Disorders
The treatment plan is not the same for everyone, as everybody has their own set of bipolar disorder symptoms, along with other contributing factors like one’s immediate surroundings, daily schedule, stress levels, etc.
For all bipolar disorders, a few types of treatments have been shown to help:
Medication, most commonly used being lithium, mood stabilizers, and antipsychotics.
Behavioral therapy, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT) and some others.
Support and self-care groups entered alone or with family and friends. These help to create a sense of community and relieve the feeling of isolation and otherness.
How bipolar disorder affects sleep
After learning more about the types of episodes that occur in people with bipolar disorder, it’s no surprise that sleep issues would follow these. During manic episodes, a person can go a few days with barely any or no sleep while being overly active and spending more energy than their body can handle. After the episode is done, this debt catches up, resulting in major fatigue and a disrupted sleep pattern. Depressive episodes, on the other hand, come with sleep issues generally linked to clinical depression, like insomnia, hypersomnias and excessive daytime sleepiness.
Vice versa applies as well – sleep deprivation and other sleep-related difficulties make bipolar disorder symptoms during an episode even worse; if happening outside of an episode, they may even trigger one. Sleep issues that progressively get more annoying can also signal the beginning of the next episode.
Sleep issues linked to bipolar disorder include insomnia, hypersomnia, sleep apnea, decreased need to sleep, fatigue, and delayed sleep-wake phase disorder.
Insomnia is a sleep disorder characterized by difficulties with either sleep onset or its maintenance over the course of the night. People who have this disorder might take over an hour to fall asleep, even though they physically feel tired. Some people only struggle with one of the two symptoms of insomnia, managing to fall asleep but waking up frequently or taking long to onset sleep but then staying asleep until morning. In any case, people who experience this disorder suffer excessive daytime sleepiness and poor sleep quality. Studies have shown that almost all people with bipolar disorder experience insomnia in depressive episodes.
The over-sleeping disorder affects over 78% of people with bipolar disorder according to recent studies. For comparison, out of the unipolar population, only about 4% are affected by this disorder. As with insomnia, long sleep hypersomnia issues usually happen during a depressive episode or signal the beginning of one. However, excessive daytime sleepiness (wishing to sleep more) may signal the proximity of a manic episode instead.
Decreased Sleep Needs
At first glance, this issue looks similar to insomnia, but in reality, they are easily distinguished by a simple difference. People who have insomnia can’t fall or stay asleep despite their physical tiredness. They want to sleep; it is just that they achieve this goal with difficulties. On the other hand, people who experience decreased need to sleep don’t physically feel tired because the mania powers them, so to speak. Although the sleep deprivation takes a toll on their body, they only feel tired after the manic episode is over, and the sleep debt swamps them. An estimated 99% of people with bipolar disorder experience decreased need to sleep during a manic episode.
This form of sleep-disordered breathing describes a sudden airway blockage that happens when one’s asleep, often occurring in people with obesity. It is also frequent among the people with bipolar I disorder. The suggested treatment for severe cases of apnea involves CPAP therapy, a mask worn during sleep to help keep the airways open. However, in some cases, this method might trigger the symptoms of mania and may not be appropriate for people with bipolar disorder.
The least surprising, often constant sleep-related issue universally experienced by people with all types of bipolar disorder, fatigue occurs as a result of big fluctuations in moods and energy between manic and depressive episodes. After the sleep deprivation typical for periods of mania, the person is physically and emotionally exhausted, making it easy to fall straight into depression.
Delayed Sleep-Wake Phase Disorder (DSPD)
This circadian rhythm disorder isn’t rarely provoked by extreme sleep pattern changes in people with more severe types of bipolar disorder. People who have this disorder have a later bedtime than average, meaning they naturally fall asleep but also wake up later. It causes a lot of difficulties to accommodate school and work schedules. In attempts to do that, people with DSPD often try to forcefully wake up earlier than they normally would, resulting in daytime sleepiness and fatigue.
While sleep issues frequently comorbid bipolar disorders, treating both is possible and methods vary between different problem combinations. We listed some common methods below to give you a general idea of how a treatment procedure might go.
Cognitive behavioral therapy is an overall helpful treatment method, used for a vast scale of different sleep disorders. The method is simple and pill-free; works by setting up a set of steps to help form a base of a healthy relationship with sleep.
Light therapy used strategically can help solve different types of sleep problems by boosting the body’s circadian rhythm and alerting you to stay awake until the desired bedtime. Unless otherwise specified, this method is used only in the morning or early afternoon.
Melatonin supplement is commonly used to complement light therapy. This supplement is a form of a hormone that is produced in our brains shortly before and during sleep and has a role in inducing this process. Melatonin is supplemented in a prescribed dose before going to bed and has virtually no health risks unless taken in large doses.
Some drugs like benzodiazepines are used to treat bipolar disorder but also insomnia. If you are taking this or any other drug for bipolar or sleep disorder, talk to your doctor about side-effects and risks. Unless carefully instructed by a specialist, don’t combine any two medications; otherwise, you will needlessly put yourself at great risk.
If you find yourself less than satisfied with treatment results or think there might be some better therapy method to try, discuss it with your doctor before taking any action or giving up altogether. Lastly, don’t forget that any method of treatment alone won’t work unless you do your best to cultivate healthy sleep hygiene. Diet, exercise, and stress levels are just some external factors that play a role in how well you sleep. Whether this role will be positive or negative is up to you.