Bipolar Disorder and Sleep Problems: What to Do

Unfortunately, people with bipolar disorder report sleep problems frequently. This is likely due to the way the circadian rhythm (body clock) of a person with bipolar disorder is dysregulated. In fact, some people consider bipolar disorder a disorder of the circadian rhythm. The circadian rhythm regulates sleep, appetite, cognitive functions and metabolism, among other physiological processes. It’s also notable that day-to-day activities often vary dramatically for one with bipolar and this is also thought to be due to circadian rhythm dysregulation.

It is no surprise, then, if a circadian rhythm is off, bipolar and sleep problems occur. These sleep problems lead to decreased quality of life and impaired functioning. Learn about the type of sleep problems people with bipolar disorder have and how to address them below.

Bipolar Sleep Patterns

The average person may experience sleep disturbance now and then – this is normal. But someone with bipolar disorder may experience nearly constant sleep disturbance. People with bipolar disorder often have trouble with:

• Falling asleep
• Waking up and feeling refreshed; daytime wakefulness
• Staying asleep throughout the night (sleep continuity)
• Quality of sleep
• Sleep timing
• Nightmares

The sleep patterns in bipolar disorder can make mood episodes worse, and yet altering these patterns also runs the risk of, at least initially, causing mild hypomanic symptoms.

The First Step in Addressing Bipolar Sleep Pattern Problems

The first step in addressing bipolar disorder and sleep problems is to regulate the sleep-wake cycle. This means one must:

• Go to bed at the same time every night
• Get up at the same time every morning

This, obviously, also means that you get the same amount of sleep every night (at least eight hours). It’s important that no change be made to this schedule – that means no sleeping in on the weekends.

In a series of patients who underwent treatment for insomnia, it was found that regulating bedtimes and wake times was often sufficient to bring about an increase in sleep quality.

People find it difficult to regulate their sleep in this way. People often naturally want to change their sleep hours in order to go out with friends, work a late night shift or get up early to go to the gym twice a week. And while these alterations might be okay for the average person, these changes will absolutely sabotage an attempt at better sleep.

For more on bipolar and insomnia, see Solutions for Bipolar and Insomnia: I Can’t Sleep.

Bipolar Disorder and Sleep Medication

There are sleep medications available for those with bipolar disorder. Some of these are specifically approved for sleep while others are used off label (approved for another use but used to treat sleep problems).

Classes of medications used to treat sleep problems in bipolar disorder include:

• Antidepressants – Some antidepressants are sedating. These are not habit-forming and include trazodone (Desyrel) and mirtazapine (Remeron).
• Antipsychotics – not habit forming; typically quetiapine (Seroquel) is used.
• Benzodiazepines, long-acting – these can be habit-forming and include clonazepam (Klonopin).
• Benzodiazepines, short-acting – these can be habit-forming and include lorazepam (Ativan) and alprazolam (Xanax).
• Melatonin receptor agonists – ramelteon (Rozerem; not habit-forming; approved for long-term use)
• Non-benzodiazepines (also known as sedative-hypnotics) – these can be habit-forming and include medications like eszopiclone (Lunesta) or zolpidem (Ambien).
• Over-the-counter sleep aids – antihistamines; possibly habit-forming, including diphenhydramine under various brand names like Sleep-Eze and Benadryl and doxylamine under various brand names including Unisom.
• Supplements and herbs – these come with various risks and include melatonin and valerian root (Natural Herbs, Supplements for Bipolar Disorder).

See more bipolar sleep medications.

Additionally, the medication armodafinil (Nuvigil), which is considered a wakefulness-promoting agent, may help with daytime sleepiness and may also be effective in treating bipolar depression.