Good sleep hygiene is the keystone of bipolar mood management. Find out what’s causing your sleep disturbances, how mood stabilizers can help, and healthy habits that can help you get some rest. The Link Between Sleep Patterns and Mood...
Good sleep hygiene is the keystone of bipolar mood management. Find out what’s causing your sleep disturbances, how mood stabilizers can help, and healthy habits that can help you get some rest.
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The Link Between Sleep Patterns and Mood Disorders
Most nights, Will J. has no interest in going to bed. He prefers catching up on work, logging a few hours on his flight simulator, or watching late-night TV to crawling under the covers and counting sheep.
“Sleeping feels like a waste of time,” admits Will, who is in his early sixties and a software developer in Alberta. “I’d rather be productive, doing things, instead of going to bed.”
Will has never slept much. As a child, he struggled to fall asleep when his parents declared it bedtime and he would often lie in the dark, wide awake. Those sleepless nights followed him into adulthood, leading Will to believe that he required less sleep than others. He averaged six hours of sleep per night, dropping to as few as two hours a night if he was under stress.
It wasn’t until he was diagnosed with bipolar disorder in 2003 that Will learned his sleep habits could be linked to the illness. He’s not alone.
Sleep disturbance is one of the hallmarks of mood disorders, including bipolar disorder, according to Jamie Lilie, PhD, a licensed clinical psychologist who is board-certified in sleep disorders medicine.
“There is a strong relationship between our sleep patterns and the regulation of mood,” Dr. Lilie explains. “For those living with bipolar disorder, sleep disruptions can have adverse effects and could trigger depression or mania.”
The Many Benefits of a Good Night’s Sleep
The National Sleep Foundation describes sleep as a state of deep relaxation when breathing slows, blood pressure drops, and muscles are relaxed. It’s the time when tissue growth and repair occurs, hormones that promote muscle development and growth are released, and energy is restored.
For those living with bipolar, it can be difficult to sleep for the recommended eight hours per night, in part because the desire to sleep — or to not sleep — changes depending on mood. In a manic or hypomanic phase, sleep tends to take a backseat to wakefulness, either because those living with bipolar are too alert or productive to want to go to bed, or because their mood makes them believe sleep is unimportant. The opposite is true during a depressive phase when their bodies and minds crave more than eight hours of sleep a night, whether or not there is still a biological need for sleep.
In fact, it’s not just the desire to sleep too much or too little that characterizes bipolar disorder. A review of 22 studies found that there are changes in the sleep architecture — the distinct phases of sleep — in those living with bipolar.
How Bipolar Disorder Affects Sleep Cycles
During the night, sleep moves between two stages, REM (Rapid Eye Movement) and non-REM, or NREM. NREM is the first stage — the period of drifting off to sleep. The first REM state kicks in about 90 minutes after falling asleep and recurs at 90-minute intervals throughout the night. It’s the stage when the brain is active and dreams occur. It appears that bipolar disorder affects both the REM and NREM stages. It’s unclear what triggers the changes in REM and NREM sleep, but those changes are linked to both manic and depressive states in bipolar disorder.
Pam H., a retiree in Westminster, Maryland, has no idea how long her REM and NREM stages last; what she does know is that her mood affects her sleep patterns. She sleeps fewer than six hours a night during manic episodes and upwards of nine hours a night (plus naps) when she’s depressed.
“For a long time, I tolerated [the need for different amounts of sleep] because I thought it was normal for me,” says Pam. “When I was diagnosed, I learned that the sleep issues were part of having bipolar disorder.”
According to a report in Psychiatric Times, “the average individual with bipolar spends half their life struggling with mood symptoms and the other half struggling with sleep.” And insomnia remains a persistent issue for 70 percent of people, even during periods of mood stability. This sleep disturbance increases their risk of experiencing further episodes of mania and depression.
Jenny H. understands. Like most new moms, she didn’t get much sleep after her son was born. Those sleepless nights triggered mania, leading doctors to diagnose Jenny with bipolar disorder that same year. Doctors cautioned Jenny about the importance of establishing regular sleep and wake patterns but it took the new mom from Derby, Kansas time to make the needed changes.
“I had to make a conscious choice to find the ‘off’ switch and get some rest,” explains Jenny. “Even when the voice of mania is telling me it’s okay to stay awake, I’ve learned that I need to get some sleep.”
Yoga and meditation are go-to practices that help Jenny calm her mind and fall asleep. She’s also established a regular bedtime and wake time, which has helped her create a healthy sleep pattern.
Erratic Sleep Can Trigger Mood Troubles
There is another reason that it’s essential to establish good sleep patterns: Sleep disturbance can contribute to relapse, triggering manic or depressive episodes.
“Not prioritizing sleep is a risk for mood disorders,” affirms Allison Harvey, PhD, professor of clinical psychology and director of the Golden Bear Sleep and Mood Research Clinic at the University of California–Berkeley. “In particular, sleeping too little does appear to trigger manic episodes.”
And it doesn’t take weeks of sleeplessness to trigger mania. Even small shifts in sleep habits — getting caught up in a late-night chat session, going to a wedding and dancing until the wee hours — can have consequences. Mania, on the other hand, causes a reduced desire to sleep and that can make the mania worse.
“There is a strong correlation between healthy sleep patterns and regulation of moods,” notes Lilie. “The bottom line is that people with mood disorders should not disrupt their sleep patterns.”
A series of sleepless nights triggered manic episodes that led Will to be hospitalized on three separate occasions. Before his last hospitalization in 2003, he recalls watching TV until 4 a.m.and sleeping just a few hours a night. He’s careful not to repeat that pattern, knowing that lack of sleep can trigger his manic episodes.
While there is a clear connection between a lack of sleep and the onset of manic or hypomanic episodes, the same does not hold true for depression. Sleeping too much doesn’t appear to trigger a depressive episode. That being said, it is thought that increased sleep — or spending time in bed at the expense of doing social or other fulfilling activities — could contribute to the length of a depressive episode.
The Impact of Sleep Disturbances on Relationships
Slipping into mania isn’t the sole reason Will tries hard to regulate his sleep habits. Sleeping too little makes him irritable and agitated, which, in turn, has affected his relationship with his wife. The couple began sleeping in separate bedrooms because his late nights and restless sleep made it impossible for them to sleep together.
“It’s hard on our marriage,” he says.
It didn’t take long for K.O. of Richmond Hill, Georgia, to see how her diagnosis of bipolar disorder would impact her relationship with her boyfriend. The biggest problem the couple faced: her sleep disturbances. During her depressive episodes, the veterinarian sleeps 11 hours a night, often going to bed at 7:30 p.m.
“He’d get frustrated that I was in bed all the time and that made me want to sleep even more,” K.O. recalls. “We stopped spending time together and we drifted apart.”
The more the couple struggled, the more time K.O. spent in bed.
Other Factors That Complicate Sleep
Getting a good night’s sleep isn’t as simple as crawling into bed and staying there for eight hours. It’s just as difficult to fall asleep during mania as it is to get out of bed during depression.
It’s also possible that poor habits are to blame — at least in part — for sleep disturbances. Consuming caffeine in the evenings, falling asleep in front of the television, and intense workouts before bed can all have a negative impact on sleep.
Excess weight might also be to blame. Those living with bipolar disorder who are also overweight or obese are more apt to have trouble sleeping. That’s why weight management is an important part of dealing with sleep disturbances.
To determine what might be having the biggest impact on a good restful slumber, Allen Doederlein, executive vice president of external affairs for the Depression and Bipolar Support Alliance, suggests keeping a sleep journal.
His advice: Write down all of the important details, including sleep and wake-up times, time and content of meals and caffeine, use of stimulants such as cigarettes, and time and dose of medications taken. Viewed as individual habits, it might not seem like one thing has an impact.
But being able to look back could help uncover patterns. Perhaps a night of tossing and turning tends to follow pre-slumber ice cream binges and a too-late bedtime. Or, alcohol and stress lead to spending too much time tucked beneath the covers. After keeping a sleep journal for two weeks, patterns should start to emerge.
“Establishing a regular sleep pattern is one of the most important self-care techniques people living with bipolar can do to manage their illness,” says Doederlein. “A sleep journal is a good first step toward setting up those good habits.”
Potential Pitfalls of Mood-Stabilizing Medications
In addition to doing what their name suggests, mood-stabilizing medications may also improve sleep because of the mild sedatives they contain.
According to Lilie, one of the benefits of mood stabilizers is that their sedative effect means there’s no need for an additional sleeping pill. “It’s important to take [mood stabilizers] before bed so their sedative properties are strongest throughout the night,” she says. Taken in the morning, Lilie warns, mood stabilizers could cause sleepiness throughout the day.
K.O. used to nap in the afternoons, sleeping for up to three hours after work. After changing her medicine regimen, her napping stopped.. K.O. says, she has more energy to spend with her boyfriend.
While switching or adjusting medications can be helpful in addressing some of the causes of sleep disturbance, it is not always the answer. A doctor will assess whether the potential risks of a new medication or a different dosage outweigh the benefits, and can also monitor the effectiveness of new prescriptions.
Will is certain that establishing good sleep habits is essential for keeping his moods in check. He goes to bed no later than 1 a.m. and aims to sleep at least seven hours each night, whether or not he is experiencing depression, mania, or a stable mood.
“Just like an alcoholic has to be vigilant about alcohol, I have to be vigilant about sleep,” he muses. “Sometimes I slip; I fall off the wagon and into a bad habit of failing to go to sleep. I work at getting it right because I know that [a good night’s sleep] affects my mood and mental health.”
Editorial Sources and Fact-Checking
What Happens When You Sleep. Sleep Foundation. August 2022.
Zangani C et al. Sleep Abnormalities Across Different Clinical Stages of Bipolar Disorder: A Review of EEG Studies. Neuroscience & Biobehavioral Reviews. November 2020.
Aiken C. New Directions for Insomnia and Bipolar Disorder. Psychiatric Times. February 2022.
UPDATED: Originally printed as “Slumber Solutions,” Winter 2011
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