Bipolar disorder is a mental health condition that causes extreme changes in mood and energy. It can also affect other aspects of a person’s health, including sleep. Treatment for insomnia may involve cognitive behavioral therapy or sleeping aids.

People with bipolar disorder experience extended episodes of mania or depression. Mania episodes are defined as periods of high energy, impulsivity, and irritability. Depressive episodes are defined as periods of fatigue, intense sadness, and loss of interest in activities.

Many people with bipolar disorder also experience sleep problems, which can further affect symptoms.

This article explores the connection between bipolar disorder, the circadian cycle, and sleep issues.

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Sleep disturbances are a core feature of bipolar disorder. They are included in descriptions of both manic and depressive episodes that doctors use for diagnosis.

People may feel a decreased need for sleep during manic episodes. They may go days with little to no sleep without feeling tired. During depressive episodes, they may sleep excessively or may have difficulty sleeping.

People with bipolar disorder may also experience sleep issues between episodes. Research from 2015 suggests many people with the condition have difficulties falling asleep and staying asleep during intervals between manic or depressive episodes.

This can be problematic since sleep disturbances can trigger mood episodes in people with or at risk of bipolar disorder.

Certain sleep issues, such as nightmare disorders, have also been found to increase the likelihood of suicide in adolescents with bipolar disorder.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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Experts believe that sleep difficulties in bipolar disorder result from changes to the body’s natural circadian rhythm.

“Circadian rhythm” refers to the biological processes that regulate all the body’s usual daily rhythms. This includes sleep-wake cycles, body temperature changes, hormone levels, hunger cues, and more.

Experts have found that bipolar disorder disrupts the circadian rhythm. This may be due to genetic changes or damage to the part of the brain that regulates these cycles.

Some of these changes may be present before the condition develops. One 2019 study found that people considered high risk for bipolar disorder are prone to experiencing sleep disturbances and have more daytime sleepiness.

Similarly, a 2022 study found that people with genetic features that may predispose them to insomnia are approximately 12% more likely to develop bipolar disorder than those without the genetic elements.

The relationship between bipolar disorder and sleep is likely complex and bidirectional. A collection of changes in the chemistry and structure of the brain may make people more susceptible to both circadian rhythm and mood dysregulation.

Additionally, mood dysregulation in bipolar disorder may disrupt circadian rhythm and vice versa. As a result, mood episodes and sleep issues become a continuous cycle in people with bipolar disorder.

Improved sleep is an important treatment goal in bipolar disorder. Many treatment plans include interventions to improve and maintain quality sleep.

According to clinical trial results published in 2015, using cognitive behavioral therapy for insomnia (CBT-I) in people with bipolar disorder can help reduce the likelihood of mood episodes and improve sleep quality.

Other types of treatment that may improve sleep in bipolar disorder include:

  • interpersonal and social rhythm therapy (IPSRT)
  • family therapy
  • psychoeducation

Many of these types of treatment include educational and behavioral components aimed at helping people with bipolar disorder practice and maintain better sleep habits.

Doctors may recommend medical sleep aids for insomnia, such as hypnotics, for some people with bipolar disorder to help improve sleep. A healthcare professional will carefully monitor the use of insomnia medications that may lead to dependence.

Sleep disturbances can also affect the treatment of bipolar disorder. According to one 2018 study, people with sleep issues were 45% less likely to have sustained responses to bipolar disorder treatment over 6 months than people without sleep issues.

The following are some frequently asked questions about bipolar disorder and insomnia.

Is insomnia a symptom of bipolar disorder?

Sleep disturbances are common in people with bipolar disorder. In particular, a depressive episode is characterized by severe insomnia.

How can a person with bipolar disorder get better sleep?

Having a vigorous exercise routine can promote better sleep in people with bipolar disorder.

Preliminary data also suggests that mindfulness could be a helpful way to encourage sleep in people living with bipolar disorder.

Sleep disturbances are common in people with bipolar disorder given the close relationship between mood, sleep, and circadian rhythm.

Many people living with bipolar disorder experience inadequate sleep during and between episodes. Sleep issues may trigger mood disturbances in some people with the condition.

People with bipolar disorder who have difficulty sleeping may benefit from a care plan that includes strategies to address sleep issues. A doctor or psychiatrist can help identify resources to help improve sleep that are compatible with a person’s treatment plan.

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