Sleep in bipolar disorder

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Sleep is known to play an important role in the etiology and maintenance of bipolar disorder.[1] Patients with bipolar disorder often have a less stable and more variable circadian activity.[2] Circadian activity disruption can be apparent even if the person concerned is not currently ill.[3][4]

A decreased need for sleep is a symptom of both a manic episode and a hypomanic episode[5] in bipolar disorder. Sleep disturbances are often a prodrome for the onset of a manic, hypomanic or depressive episode.[6][7] Current research on circadian and sleep-wake processes shows that they play an important role in the etiology and maintenance of bipolar disorder.[8] Previous studies showed that the circadian system can modulate the current mood state with positive affect.[9] When challenged, it can have negative mood consequences.[10]

The social zeitgeber hypothesis therefore proposes that in bipolar disorder the fundamental circadian instability can be moderated by the stabilization of daily rhythms and zeitgeber.[11] According to the hypothesis, a disruption (e.g. life event) could trigger depressive, hypomanic or manic episodes. Inversely, a regular daily rhythm can have a positive effect and lead to a normalization of the circadian system. The goal of treatment programs like the interpersonal and social rhythm therapy is to regulate the social rhythms of a patient and thereby normalize the biological rhythms.[11]

REM sleep in bipolar disorder[edit]

Current research on REM sleep found that REM sleep is critical in the processing of episodic emotional memories.[12] When the REM sleep activity in patients with unipolar or bipolar depression were measured, often an increased REM density was found.[13] The increased REM density in unipolar and bipolar depression might have two implications. First, it could represent a failed attempt to depotentiate negative emotional experiences during the sleep.[12] Another possible implication is that the increased REM density may pathologically reinforce negative self-narratives and maintain negative moods after sleeping.[14] Both hypotheses are not yet fully proven but show the importance of sleep and sleep disruptions in bipolar disorder and the need for further research.

Sleep disorders and bipolar disorder[edit]

The diagnosis of a bipolar disorder is linked to various sleep disorders.[15] Comorbidities include insomnia and hypersomnia.[16] Other related sleep disturbances are delayed sleep phase syndrome, circadian-rhythm sleep disorder, sleep apnea, REM sleep abnormalities and irregular sleep-wake schedules.[16]

Bipolar disorder is also linked with higher rates of suicidal ideation and suicidal attempts.[17][18] It has been shown that sleep disturbances can have an influence on the suicidality of patients with bipolar disorder.[18] One study found that poor sleep quality and nightmares can increase the risk for suicidal ideation and suicidal attempts.[18]

Genetic vulnerability[edit]

Bipolar disorder is known to have a high heritability.[19] Therefore, sleep disturbances in bipolar disorder could also have a genetic basis. Studies found modest associations between several genes that are known to be associated with the generation and regulation of circadian rhythms and bipolar disorder.[20] Two locus interactions between sleep disturbances of the rs11824092 (ARNTL) and rs11932595 (CLOCK) were found in one study.[21]

Sleep disturbances and relapse[edit]

Sleep disturbances in bipolar disorder are also an important marker for relapse. Multiple studies found evidence that sleep disturbances contribute to relapse.[20] Sleep disturbances are the most common prodrome of a manic episode and the sixth most common prodrome of a depressive episode.[20]

Sleep disturbance as a residual symptom of a bipolar disorder[edit]

Sleep disturbance is not only associated with the onset of manic or hypomanic episodes but also displays a residual symptom of manic and depressive episodes.[20] They are associated with residual depressive symptoms and perceived cognitive performance and can thereby negatively influence the functioning and recovery of a patient.[22] This is one reason why therapy programs such as interpersonal and social rhythm therapy aim to reduce sleep disturbances.[23]

Treatment possibilities regarding the sleep disturbances in bipolar disorder[edit]

Interpersonal and social rhythm therapy[edit]

A main goal of interpersonal and social rhythm therapy (IPSRT) is to regulate both circadian rhythms and sleep–wake cycles.[23] To achieve this goal, maintaining regular daily rhythms for exercising, eating, sleeping and waking are central to IPSRT. Research has shown that the sleep-wake cycle (circadian rhythms and sleep) can be moderated by social and volitional factors.[9] Based on this chronobiological model, IPSRT aims to manage bipolar symptomatology.[23]

Light therapy for bipolar disorder[edit]

A recent study also suggests that bipolar disorder is linked with an enhanced sensitivity to light.[24] In the study, four of the five women who received a midday light session responded well. Three of the four who received light in the morning developed a mixed state, and the others responded well. The authors conclude that light therapy is possibly an effective augmentation strategy in the treatment of bipolar disorder.[24]

Total or partial sleep deprivation[edit]

Another proposed treatment for sleep disturbances is total or partial sleep deprivation. Total or partial sleep deprivation has been found to induce an increased mood in depressed bipolar patients.[20] Problematically depressive symptoms often seem to return soon after the patient has slept. Two theories hypothesize, that circadian mechanisms might be the reason.[20]

According to the internal coincidence model, depressed patients are not sleeping at the right biological clock time because the phase angle between the sleep-wake cycle and the biological clock is out of alignment.[25] Based on this theory sleep deprivation works at first because it prevents sleep at the critical phase but in recovery sleep, the misalignment is reinstated.[26]

In the two process model of sleep, it has been proposed, that depression is characterized by a deficiency in the building up of process S.[27] Therefore, sleep deprivation might increase process S in the beginning, but a relapse occurs, when sleep deprivations isn't applied anymore and process S returns to a low level.[27]

References[edit]

  1. ^ Gold, A. K.; Sylvia, L. G. (2016). "The role of sleep in bipolar disorder". Nature and Science of Sleep. 8: 207–214. doi:10.2147/NSS.S85754. PMC 4935164. PMID 27418862.
  2. ^ Jackel, Donna (2019-01-04). "The Truth about the Link Between Bipolar and Creativity". bpHope.com. Retrieved 2023-11-17.
  3. ^ Jones, Steven Huntley; Hare, Dougal Julian; Evershed, Kate (2005). "Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder". Bipolar Disorders. 7 (2): 176–186. doi:10.1111/j.1399-5618.2005.00187.x. ISSN 1399-5618. PMID 15762859.
  4. ^ Harvey, Allison G.; Talbot, Lisa S.; Gershon, Anda (June 2009). "Sleep Disturbance in Bipolar Disorder Across the Lifespan". Clinical Psychology. 16 (2): 256–277. doi:10.1111/j.1468-2850.2009.01164.x. ISSN 0969-5893. PMC 3321357. PMID 22493520.
  5. ^ Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (5th ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN 9780890425541. OCLC 830807378.{{cite book}}: CS1 maint: others (link)
  6. ^ Jackson, A.; Cavanagh, J.; Scott, J. (2003). "A systematic review of manic and depressive prodromes". Journal of Affective Disorders. 74 (3): 209–17. doi:10.1016/s0165-0327(02)00266-5. PMID 12738039.
  7. ^ Sierra, P.; Livianos, L.; Arques, S.; Castelló, J.; Rojo, L. (2007). "Prodromal symptoms to relapse in bipolar disorder". The Australian and New Zealand Journal of Psychiatry. 41 (5): 385–91. doi:10.1080/00048670701266854. PMID 17464729. S2CID 32501937.
  8. ^ Murray, Greg; Harvey, Allison (2010). "Circadian rhythms and sleep in bipolar disorder". Bipolar Disorders. 12 (5): 459–472. doi:10.1111/j.1399-5618.2010.00843.x. ISSN 1399-5618. PMID 20712747.
  9. ^ a b Murray, Greg; Allen, Nicholas B.; Trinder, John (2002-01-01). "Mood and the Circadian System: Investigation of a Circadian Component in Positive Affect". Chronobiology International. 19 (6): 1151–1169. doi:10.1081/CBI-120015956. ISSN 0742-0528. PMID 12511032. S2CID 25680126.
  10. ^ Meyrer, Robert; Demling, Joachim; Kornhuber, Johannes; Nowak, Magdalena (2009). "Effects of night shifts in bipolar disorders and extreme morningness". Bipolar Disorders. 11 (8): 897–899. doi:10.1111/j.1399-5618.2009.00767.x. ISSN 1399-5618. PMID 19922558.
  11. ^ a b Grandin, Louisa D.; Alloy, Lauren B.; Abramson, Lyn Y. (2006-10-01). "The social zeitgeber theory, circadian rhythms, and mood disorders: Review and evaluation". Clinical Psychology Review. 26 (6): 679–694. doi:10.1016/j.cpr.2006.07.001. ISSN 0272-7358. PMID 16904251.
  12. ^ a b Van Der Helm, E.; Walker, M. P. (2009). "Overnight Therapy? The Role of Sleep in Emotional Brain Processing". Psychological Bulletin. 135 (5): 731–748. doi:10.1037/a0016570. PMC 2890316. PMID 19702380.
  13. ^ Krystal, A. D.; Thakur, M.; Roth, T. (2008). "Sleep disturbance in psychiatric disorders: effects on function and quality of life in mood disorders, alcoholism, and schizophrenia". Annals of Clinical Psychiatry. 20 (1): 39–46. doi:10.1080/10401230701844661. PMID 18297585.
  14. ^ Walker, Matthew P. (2009). "The Role of Sleep in Cognition and Emotion". Annals of the New York Academy of Sciences. 1156 (1): 168–197. Bibcode:2009NYASA1156..168W. doi:10.1111/j.1749-6632.2009.04416.x. ISSN 1749-6632. PMID 19338508. S2CID 313685.
  15. ^ "Bipolar Disorder: Sleep Problems and Treatments". WebMD. Retrieved 2019-07-08.
  16. ^ a b Kaplan, Katherine A.; Gruber, June; Eidelman, Polina; Talbot, Lisa S.; Harvey, Allison G. (2011-08-01). "Hypersomnia in inter-episode bipolar disorder: Does it have prognostic significance?". Journal of Affective Disorders. 132 (3): 438–444. doi:10.1016/j.jad.2011.03.013. ISSN 0165-0327. PMC 3139494. PMID 21489637.
  17. ^ Rihmer, Zoltán; Kiss, Kitty (2002). "Bipolar disorders and suicidal behaviour". Bipolar Disorders. 4 (s1): 21–25. doi:10.1034/j.1399-5618.4.s1.3.x. ISSN 1399-5618. PMID 12479671.
  18. ^ a b c Jamison, Kay Redfield (2000-07-31). "Suicide and Bipolar Disorder". The Journal of Clinical Psychiatry. 61 (suppl 9): 47–51. ISSN 0160-6689. PMID 10826661.
  19. ^ Cardno, Alastair; Katz, Randy; Sham, Pak; Andrew, Martin; Rijsdijk, Fruhling; McGuffin, Peter (2003-05-01). "The Heritability of Bipolar Affective Disorder and the Genetic Relationship to Unipolar Depression". Archives of General Psychiatry. 60 (5): 497–502. doi:10.1001/archpsyc.60.5.497. ISSN 0003-990X. PMID 12742871. S2CID 28539957.
  20. ^ a b c d e f Harvey, Allison G. (2008-07-01). "Sleep and Circadian Rhythms in Bipolar Disorder: Seeking Synchrony, Harmony, and Regulation". American Journal of Psychiatry. 165 (7): 820–829. doi:10.1176/appi.ajp.2008.08010098. ISSN 0002-953X. PMID 18519522.
  21. ^ Maciukiewicz, Malgorzata; Dmitrzak-Weglarz, Monika; Pawlak, Joanna; Leszczynska-Rodziewicz, Anna; Zaremba, Dorota; Skibinska, Maria; Hauser, Joanna (2014-07-01). "Analysis of genetic association and epistasis interactions between circadian clock genes and symptom dimensions of bipolar affective disorder". Chronobiology International. 31 (6): 770–778. doi:10.3109/07420528.2014.899244. ISSN 0742-0528. PMID 24673294. S2CID 29490762.
  22. ^ Samalin, Ludovic; Boyer, Laurent; Murru, Andrea; Pacchiarotti, Isabella; Reinares, María; Bonnin, Caterina Mar; Torrent, Carla; Verdolini, Norma; Pancheri, Corinna (2017-03-01). "Residual depressive symptoms, sleep disturbance and perceived cognitive impairment as determinants of functioning in patients with bipolar disorder". Journal of Affective Disorders. 210: 280–286. doi:10.1016/j.jad.2016.12.054. ISSN 0165-0327. PMID 28068616.
  23. ^ a b c Frank, Ellen; Swartz, Holly A; Kupfer, David J (2000-09-15). "Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder". Biological Psychiatry. 48 (6): 593–604. doi:10.1016/S0006-3223(00)00969-0. ISSN 0006-3223. PMID 11018230. S2CID 7926489.
  24. ^ a b Sit, Dorothy; Wisner, Katherine L.; Hanusa, Barbara H.; Stull, Stacy; Terman, Michael (2007). "Light therapy for bipolar disorder: a case series in women". Bipolar Disorders. 9 (8): 918–927. doi:10.1111/j.1399-5618.2007.00451.x. ISSN 1399-5618. PMID 18076544.
  25. ^ Wirz-Justice, Anna; Pühringer, Wolfgang; Hole, Günter (October 1976). "Sleep Deprivation and Clomipramine in Endogenous Depression". The Lancet. 308 (7991): 912. doi:10.1016/s0140-6736(76)90580-8. ISSN 0140-6736. PMID 62147. S2CID 41919700.
  26. ^ Wirz-Justice, Anna; Van den Hoofdakker, Rutger H (1999-08-15). "Sleep deprivation in depression: what do we know, where do we go?". Biological Psychiatry. 46 (4): 445–453. doi:10.1016/S0006-3223(99)00125-0. ISSN 0006-3223. PMID 10459393. S2CID 15428567.
  27. ^ a b Wirz-Justice, A. (2003). "Chronobiology and mood disorders". Dialogues in Clinical Neuroscience. 5 (4): 315–325. doi:10.31887/DCNS.2003.5.4/awirzjustice. PMC 3181777. PMID 22033593.
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