As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences. When sleepiness levels reach clinical significance (a score of 10 on the Epworth scale), discourage patients from driving or other potentially unsafe behaviors during periods of drowsiness. Of course, your doctor may recommend a change in medication if needed. Although all participants in our study met diagnostic criteria for insomnia, average total sleep time at baseline was 7.16 hours. For more on sleep medication, see Bipolar Disorder and Sleep Problems: What to Do. All participants were euthymic at the start of treatment, defined as the absence of diagnoses of current mania/hypomania and depression according to the Structured Clinical Interview for DSM-IV Axis I Disorders (19) and confirmed by a score ≤24 on the Inventory of Depressive Symptomatology–Clinician Version (IDS-C) (20) and a score <12 on the Young Mania Rating Scale (YMRS) (21), as research has suggested a YMRS score of 12 or greater would merit criteria for a DSM-IV-TR hypomanic episode (22). It’s common for those with bipolar disorder to experience insomnia and other sleeping problems, whether or not their mood episodes are being successfully treated with medication. We present treatment results for 15 patients who showed acceptable safety for the intervention. Of course, many things may contribute to sleep problems. Sleep restriction and stimulus control appear to be safe and efficacious procedures for treating insomnia in patients with bipolar disorder. We offer the following recommendations for addressing sleep problems in bipolar disorder without introducing pharmacological agents: Monitor sleep regularly, including time to fall asleep, time awake in the middle of the night, early morning awakenings, and daytime naps. As the name suggests, this type of therapy focuses on both behavior and cognitive changes. To evaluate the safety of each technique, weekly changes in mood were carefully assessed. Two of five patients who underwent sleep restriction reported mild hypomania that was unrelated to weekly sleep duration. Solving insomnia may be as simple as changing sleeping patterns or changing medication, but providing a doctor with the relevant information is crucial in finding both the cause of insomnia as well as the solution. One patient reported that 2 days of mood elevation coincided with psychosocial household changes, and another patient attributed 1 day of mild mood elevation to a new job prospect. Even medications for bipolar disorder may cause sleep problems. This can include exercise and TV, phone, and computer screens. When a person with bipolar can’t sleep, it’s very important to get treatment as sleep disturbances can lead to a decrease in functioning and an unstable mood. 8, Journal of Psychiatric Research, Vol. “Ms. These interventions are designed to strengthen the association between sleep and the sleeping environment, to develop a consistent sleep-wake schedule, and to strengthen the homeostatic sleep drive. Ms. D would be required to limit her time in bed to 6.5 hours per night, equivalent to her current total sleep time. Sleep 2004; 27:1567–1596Crossref, Medline, Google Scholar, 19 First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders–Non-Patient Edition. 17, No. Bipolar disorder may affect sleep in many ways. 19, No. Another treatment goal was to regularize her bedtimes and rise times. One of the issues people have with sleep is that they don’t know enough about how it works to optimize their experiences with it. 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Although two of the four developed mild hypomania in the week following stimulus control instruction, total sleep time was unchanged for these individuals, and neither reported engaging in arousing or goal-oriented behaviors at night. 16, No. APA ReferenceTracy, N. Psychiatry Res 1996; 65:121–125Crossref, Medline, Google Scholar, 6 Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL: Psychological and behavioral treatment of insomnia: an update of recent evidence (1998–2004). Another patient, who had extended awakenings in the middle of the night, reported that he monitored the time he spent out of bed by the passing trains or the number of pages he read, which heightened his insomnia-related anxiety. It takes her up to 2 hours to fall asleep at night, and she reports 8 hours in bed nightly and 6.5 hours per night of sleep on average. When sleepiness levels reach clinical significance (a score of 10 on the Epworth scale), discourage patients from driving or other potentially unsafe behaviors during periods of drowsiness. After 1–2 weeks of this schedule, calculate weekly sleep efficiency with the patient; if sleep efficiency is below recommended guidelines, consider implementing sleep restriction (8). Compliance with this routine should be reinforced and revisited weekly. The goal is to raise sleep efficiency, defined as total sleep time divided by time in bed, to 85%−90% (80% in older adults). 2, 23 March 2020 | European Psychiatry, Vol. For three out of four people with bipolar disorder, sleep problems are the most common signal that a period of mania is about to occur. Insomnia can also exacerbate problems with cognitive functioning areas like attention, memory, concentration and critical thinking. Am J Psychiatry 2008; 165:820–829Link, Google Scholar, 10 Millar A, Espie CA, Scott J: The sleep of remitted bipolar outpatients: a controlled naturalistic study using actigraphy. Introduce stimulus control and explain the rationale to patient, underscoring the role of conditioning factors in maintaining insomnia (7, 8). New York, New York State Psychiatric Institute, Biometrics Research, 1997Google Scholar, 20 Rush AJ, Gullion CM, Basco MR, Jarrett RB, Trivedi MH: The Inventory of Depressive Symptomatology (IDS): psychometric properties. In a series of patients with bipolar disorder who underwent behavioral treatment for insomnia, the authors found that regularizing bedtimes and rise times was often sufficient to bring about improvements in sleep. Monitor sleepiness regularly using an instrument such as the Epworth Sleepiness Scale. ... which can be provided by the treating psychiatrist or by a non-MD counselor working in parallel with the prescribing physician. To institute standard sleep restriction and stimulus control, Ms. D was asked to limit her time in bed to 6.5 hours per night and to get out of bed if she was unable to sleep. Sleep 2000; 23:237–241Crossref, Medline, Google Scholar, 29 Bauer M, Grof P, Rasgon N, Bschor T, Glenn T, Whybrow PC: Temporal relation between sleep and mood in patients with bipolar disorder. 2, Current Psychiatry Reports, Vol. Medical devices like CPAP machines may be necessary if insomnia is caused by conditions like sleep apnea as opposed to purely psychological stressors. Two of these four individuals were introduced to sleep restriction; the first reported mood elevation lasting 2 days that coincided with the first week of sleep restriction, and the second reported mood elevation 4 weeks after sleep restriction was introduced. 59, No. Work with patients to review the main components of the tools and anticipate with patients any setbacks to sleep, along with how stimulus control and sleep restriction can be used to prevent the re-emergence of insomnia. There are two types of insomnia- acute and chronic.
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