Excerpts from Dr. Fieve's Book on Sleep in Bipolar Disorder

What is delayed sleep phase syndrome and an irregular sleep-wake schedule?

Sleep disturbances are common in people with bipolar disorder and often are tied into the vicious cycling of moods that occur in this disorder.

Let's hear from an expert, Dr. Ronald R. Fieve, about sleep in bipolar disorder.

Who is Dr. Fieve?

Dr. Ronald R. Fieve, a professor of clinical psychiatry at Columbia University and a private practice psychiatrist, who has published more than 300 scientific papers in the field of bipolar and depression research.

Below are all excerpts from his book, Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression - The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder.

All have been reprinted with permission.

Insomnia in Bipolar Disorder

How is your sleep? Do you have difficulty falling asleep? Or do you toss and turn most of the night until you fall into a deep sleep just hours before the alarm goes off? A person suffering from insomnia has difficulty initiating or maintaining normal sleep, which can result in non-restorative sleep and impairment of daytime functioning. Insomnia includes sleeping too little, difficulty falling asleep, awakening frequently during the night, or waking up early and being unable to get back to sleep. It is characteristic of many mental and physical disorders. Those with depression, for example, may experience overwhelming feelings of sadness, hopelessness, worthlessness, or guilt, all of which can interrupt sleep.

Hypomanics, on the other hand, can be so aroused that getting quality sleep is virtually impossible without medication. In a study at the University of Oxford in the United Kingdom, Allison G. Harvey, PhD, and colleagues in the department of experimental psychology determined that even between acute episodes of bipolar disorder, sleep problems were still documented in 70 percent of those who were experiencing a normal (euthymic) mood at the time.

These normal-mood patients with bipolar disorder expressed dysfunctional beliefs and behaviors regarding sleep that were similar to those suffering from insomnia, such as high levels of anxiety, fear about poor sleep, low daytime activity level, and a tendency to misperceive sleep. Dr. Harvey concluded that even when the bipolar patients were not in a depressive, hypomanic, or manic mood state, they still had difficulty maintaining good sleep.

Delayed Sleep Phase Syndrome in Bipolar Disorder

This is the most common circadian-rhythm sleep disorder that results in insomnia and daytime sleepiness or somnolence. A short circuit between a person's biological clock and the 24-hour day causes this sleep disorder. It is commonly found in those with mild or major depression. In addition, certain medications used to treat bipolar disorder may disrupt the sleep-wake cycle. I often recommend chronotherapy to patients. This therapy -- an attempt to move bedtime and rising time later and later each day until both times reach the desired goal -- is often used to adjust delayed sleep phase syndrome. To adjust the delayed sleep phase problem, sleep specialists might also use bright light therapy or the natural hormone melatonin, particularly in depressed patients.

Irregular Sleep-Wake Schedule in Bipolar Disorder

This sleep disorder is yet another problem that many with Bipolar II experience and in large part results from a lack of lifestyle scheduling. The reverse sleep-wake cycle is usually experienced by bipolar drug abusers and/or alcoholics who stay awake all night searching for similar addicts and engaging in drug-seeking behavior, which results in sleeping the next day. This sleep disruption and irregularity make it much more difficult for the bipolar patient's physician to treat him or her with conventional medications and adjunctive cognitive therapy.

In most cases, the patient needs to acknowledge the drug-seeking behavior and get involved in a recovery program such as Alcoholics Anonymous, Cocaine Anonymous or other group. Talk therapy with a psychologist is beneficial to many patients as they seek to change destructive lifestyle habits and learn new behaviors that will help them adhere to a more normal sleep-wake schedule.

What Should I Do?

If you suffer from bipolar disorder and sleep problems, please speak with your doctor and be honest about your concerns. Your sleep is likely affecting your mood and behavior. Take care of your body, both when awake and when sleeping. 


Reprinted from: Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression - The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder by Ronald R. Fieve, M.D. © 2006 Ronald R. Fieve, M.D. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling at (800) 848-4735.

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