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 may involve cognitive behavioral therapy or sleeping aids.

People with bipolar disorder experience extended episodes of mood disturbances that can either be manic — periods of high energy, impulsivity, and irritability — or depressive.

Many people with bipolar disorder also experience sleep issues, which can further affect mood dysregulation.

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

Sleep disturbances are a core feature of bipolar disorder, 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 and 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 for bipolar disorder.

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

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, as well as 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 even 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, another 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 issues is likely complex and bidirectional. A collection of changes in the chemistry and structure of the brain may leave 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 BD.

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

According to clinical trial results published in 2015, the use of 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. Given the increased likelihood of substance use disorders among people with BD, a healthcare professional will carefully monitor the use of certain types of insomnia medications that can lead to dependency.

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.

Sleep disturbances are common in people with bipolar disorder, given the close relationship between mood, sleep, and circadian rhythm. Many people with the condition experience inadequate sleep during and between episodes, and sleep issues may trigger mood disturbances in some people.

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.