Vivid Dreams and Nightmares in People with Bipolar Disorder

Part 1: Sleep Disorders, Vivid Dreams

young woman having vivid dream
People with bipolar disorder can have extra-vivid dreams.. Ralf Nau/Stone/Getty Images

People who have bipolar disorder tend to have disturbed sleep. Specifically, they have extra-vivid dreams and lots of nightmares, coupled with the possibility of insomnia or too much sleep, depending on whether they're in a manic or depressive episode.

According to the article Stormy Sleep by Terrance Malloy, a registered polysomnographic technologist at the Atlanta School of Sleep Medicine, "Psychiatric disorders are common in sleep disorder patients, and disturbed sleep often afflicts patients with psychiatric disorders." The article notes a study showing that a very high percentage of insomniacs and hypersomniacs met the criteria for mental illness.

Good sleep is important for both mental and physical health: At least one study suggests there's evidence that poor sleep can contribute to relapses in bipolar disorder. Therefore, if you're troubled by vivid dreams, talk to your doctor about it. Some medications may be able to suppress your dreams.

Here is some information on dreams, nightmares and night terrors in bipolar disorder.

Vivid Dreams in Bipolar Disorder

Dreams and nightmares occur during rapid eye movement (REM) sleep. In normal sleepers, there is more deep sleep at first, and then as the hours pass, periods of REM sleep become longer. This general pattern, however, can be distorted or disrupted by any one of a number of sleep disorders or disturbances, many of which have been shown to be associated with bipolar disorder.

Vivid dreams are common among adults with bipolar disorder, as evidenced by the following paragraph from Bipolar II Diagnosis at

[T]here are people with depression whose most noticeable symptom is severe insomnia. These people can go for days with 2-3 hours of sleep per night. Usually they fall asleep without much delay, but wake up 2-4 hours later and the rest of the night, if they get any more sleep at all, is broken into 15-60 minute segments of very restless, almost "waking" sleep. Dreams can be vivid, almost real. They finally get up feeling completely unrested. Note that this is not "decreased need for sleep" (the Bipolar I pattern). These people want desperately to sleep better and are very frustrated. [For me, falling asleep was also difficult - could take up to an hour.]

Page 2 - Nightmares and Night Terrors

Nightmares also occur frequently in bipolar disorder. In The Reinterpretation of Dreams, the authors write:

Bipolar patients report bizarre dreams with death and injury themes before their shift to mania (Beauchemin and Hays, 1995). Beauchemin and Hays (1996) found that dreams of bipolar depressed patients have more anxiety than those of unipolar patients. Dreams of bipolar patients, particularly those with rapid cycling, may show evidence of the subsequent shift prior to noticeable affective and behavioral changes (Frayn, 1991).

Children who suffer from bipolar disorder suffer disproportionately from nightmares. Night Terrors in Children with Bipolar Disorder notes that for these children, dreams of explicit violence, gore and death are a common symptom.

Authors Papolos and Papolos also wrote, "Many of these children suffer night terrors and fears of abandonment and annihilation. Whereas most children sleep and dream and have a nightmare or bad dream once in a while, many children with bipolar disorder are trapped through the night in hour after hour of night terrors (parents may not even realize it because often the children do not truly wake up but seem in anesthetized states)."

Night Terrors and Other Conditions

Night terrors and conditions such as sleepwalking, restless leg syndrome, bruxism (teeth grinding) make up an overall group of disorders called parasomnias.

Night terrors do not occur during REM sleep and are not dreams, although they have nightmarish elements.

They occur instead either during deep sleep or in a transitional state between deep and dreaming sleep and are a form of what doctors call "confusional arousal disorder."

When a child is experiencing a night terror and actually remembers it, he or she later reports dreams that are extremely threatening. The content has to do with some predatory person or animal chasing them, or terrible fears of abandonment such as their parents being killed. Some adults who suffer them and seem to have greater recall speak of ceilings and walls pushing down on them, and others report snakes and spiders slithering and crawling all over the bed or room" (Bipolar Child Newsletter, January 2000).

Night terrors are rare in adults, yet Papolos and Papolos cited a 1999 study by Dr. Maurice Ohayon which found that bipolar disorders and depression with anxiety were the most common factors associated with adults who reported night terrors.

In these episodes, people are known to appear to awaken, recognize no one, and exhibit symptoms of extreme fear, even screaming, thrashing around or running from the bedroom. Dr. Alan Greene suggests an interesting theory and treatment for a child with night terrors who is at potty-training age.

Page 1 - Bipolar, Sleep Disorders and Vivid Dreams

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