Bipolar and Bad Sleep -- Which Came First, How to Treat?

From what I can tell, bipolar and sleep are intimately related -- bad sleep and bipolar are linked too. In my experience\, bad sleep equals bad bipolar. But it also seems to be the case that bad bipolar equals bad sleep. So, which came first? How do you treat bad sleep and bad bipolar?

Bad Sleep Affects Bipolar

When the Sleep's Away, the Bipolar Will Play

In my opinion, maintaining a strict sleep schedule is the number one thing you can do to improve your bipolar disorder. It's absolutely right up there with taking your medication as prescribed (note it is not to be treated as a substitution for medication). I know people find this really hard, and there's a reason for this -- bipolar messes with your circadian rhythm (your biological clock that tells you when you sleep and wake). In fact, the genes with the closest connection to bipolar disorder also control the circadian rhythm.¹ It's this close genetic relationship that may indicate why sleep schedules are so important. Of course, it may also be why creating one is so hard for people with bipolar disorder.

Watch this video for my experience with insomnia and bipolar disorder.

As I said in the video, a lack of sleep sort of feels like a bad hangover that affects your body and brain. It feels like being sick. 

When I was really tired, my mother would always say, "Well, you'll sleep well tonight."

Oh, if only it were that simple. I've found that bad sleep creates bipolar symptom issues, yes, but I've also found that bad sleep causes bad sleep.

Bipolar Affects Sleep

And, of course, it doesn't surprise anyone that bipolar disorder affects sleep. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (the manual used to diagnose mental illness in the United States), both insomnia and hypersomnia (sleeping too much) are possible symptoms of depression in bipolar disorder. Additionally, mania or hypomania can have a diminished need for sleep as a symptom. So, depressed, manic, hypomanic, or mixed, your sleep might be all messed up.

And in my experience, if I don't get my sleep under control in a hypomanic episode, the hypomanic episode will just continue and worsen, leading to less sleep, leading to worse bipolar, etc.

Bad Sleep and Bipolar Disorder

So, how do you know which came first, the bad sleep or the bipolar disorder symptoms?

Well, I actually think it doesn't matter. When you look at the problem, you need to treat each side of the equation together. 

In theory, treating the bipolar disorder should even out your sleep. However, this often isn't the case. Often, the sleep issue has to be treated alongside the bipolar disorder symptoms. 

Some options for treating sleep issues include:²

• Having good sleep hygiene (this should always be a priority)
• Certain antidepressant medication
• Sedative-hypnotic medication
• Orexin inhibitors (this class of medication is new)
• Cognitive behavioral therapy for insomnia
• Relaxation therapy/exercises
• Melatonin
• Diet and exercise
• A lightbox (never start lightbox treatment without consulting your psychiatrist)

My sleep has changed over the years, but my current insomnia isn't responding well to any of the above. But that's me. I've always been rather difficult.

Long story short, if you have bipolar disorder and you aren't sleeping well, you need to talk to your doctor, and your sleep treatment needs to be a part of your bipolar disorder treatment plan. (And while you're thinking about sleep, consider tracking it, too, to see if there are any external factors that are affecting it.)

Check out our sleep disorder resources and support page here.

Sources

1. Phelps, J., "Bipolar Disorder, Light, and Darkness." PsychEducation.org, September 17, 2014.
2. Chawla, J, Insomnia Treatment and Management. Medscape, January 27, 2022.