15 During depression, sleep disruptions are commonly exhibited as hypersomnia or excessive sleepiness. During mania or hypomania, sleep disruptions are commonly presented as a reduced need for sleep with studies finding that 69%–99% of bipolar individuals report a lessened need for sleep during a manic episode or difficulties in falling and/or staying asleep. Sleep disturbances can manifest differently at various stages of the illness. Further, sleep disturbances are not unique to symptomatic bipolar patients studies have noted the presence of sleep problems in euthymic (or remitted) bipolar patients, 9, 14 highlighting the importance of sleep as a treatment target throughout all stages of the bipolar illness. 12 Such sleep disturbances occur across all stages of the illness such as directly preceding a mood episode and during an acute mood episode (eg, a depressive, manic, or mixed episode). 9– 11 Sleep disturbances are often highly comorbid with other psychiatric conditions and maladaptive health behaviors such as substance-use disorders, 12 anxiety disorders, 13 increased weight and obesity, and lack of physical activity. Sleep disturbances are highly prevalent among bipolar patients and exert a detrimental impact on course of illness, self-reported quality of life, functioning, symptom burden, and overall treatment outcomes. 2 Given that sleep disruptions are key symptoms of both the manic and depressive phases of bipolar I and II disorders, we chose to consider bipolar I and II together for the purposes of this manuscript. Patients with bipolar II disorder also have experienced at least one major depressive episode. Bipolar II disorder is characterized by one or more episodes of hypomania or a period of elevated mood lasting for only 4 days and with fewer symptoms than mania and is not associated with any impairment. 2 Many patients with bipolar I disorder also experience periods of depressed mood. Episodes of mania are characterized by at least 1 week of specific symptoms such as perceptions of grandiosity, increased flight of ideas, racing thoughts, increased talkative behaviors, reduced need for sleep, impulsive behaviors, distractibility, and heightened risk-taking that impairs one’s ability to function. The first subtype, bipolar I disorder, is marked by one or more lifetime episodes of mania or a continuously elevated or irritable mood. 1, 4, 6, 8īipolar disorder is largely considered in terms of two diagnostic subtypes that vary with regard to mood episode characteristics, presentation, and episode severity. ![]() 1, 7 In addition to increasing mortality risk, such comorbidities result in reduced quality of life and overall poor mental health, thus contributing to continued mood symptoms and a worsened course of bipolar illness. 6 Many bipolar patients also suffer from comorbid psychiatric conditions such as anxiety disorders and substance-use disorders. 5 Research indicates that >50% of bipolar patients experience one or more medical comorbidities associated with poor health behaviors (eg, physical inactivity and cigarette smoking), side effects from pharmacological treatments (eg, weight gain), and nonadherence to established treatment regimens. 2 Regarded as the sixth leading cause of disability internationally, 3 bipolar disorder is associated with standard mortality rates ranging from 1.9 to 2.1, 4 resulting from cardiovascular disease (CVD), diabetes mellitus, pneumonia, influenza, chronic pulmonary obstructive disease, and suicide, among other factors. These findings highlight the importance of targeting novel treatments for sleep disturbance in bipolar disorder.īipolar disorder, a severe and chronic mental illness with a lifetime prevalence of ~1.0%, 1 is characterized by alternating episodes of depressed and elevated mood. Biomarkers of depressive episodes include heightened fragmentation of rapid eye movement (REM) sleep, reduced REM latency, increased REM density, and a greater percentage of awakenings, while biomarkers of manic episodes include reduced REM latency, greater percentage of stage I sleep, increased REM density, discontinuous sleep patterns, shortened total sleep time, and a greater time awake in bed. A convergence of evidence suggests that sleep problems in bipolar disorder result from dysregulation across both process C and process S systems. We examine the partnership between circadian system (process C) functioning and sleep–wake homeostasis (process S) on optimal sleep functioning and explore the role of disruptions in both systems on sleep disturbances in bipolar disorder. ![]() Sleep disturbances in bipolar disorder are present during all stages of the condition and exert a negative impact on overall course, quality of life, and treatment outcomes. Bipolar disorder is a serious mental illness characterized by alternating periods of elevated and depressed mood.
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