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Bipolar Disorder
The Bipolar Sleep Connection
New studies show how circadian rhythm may play a role in the disorder.
Updated October 14, 2023 Reviewed by Ray Parker
Key points
- Sleeplessness is known to be a trigger for bipolar mood episodes.
- Circadian rhythm disruptions are common in bipolar disorder, and there may be a genetic basis for this.
- Regulation of sleep patterns through behavioral, interpersonal, and psychiatric means could be a treatment.
As a therapist, few conditions have been more complex in my eyes than bipolar disorder.
The creativity and compassion of affected individuals have dazzled me. Indeed, research supports a link between high levels of creativity and bipolar disorder (Santosa et al., 2007). Parallel to this, I have rarely seen a level of pain like that of a person living with bipolar disorder who has sunken into a deep depression or experienced the relationship fallout that tends to accompany a manic high. It would be difficult not to feel a connection.
Most people are aware that sleeplessness can ignite mood issues in people, which typically resolve quickly after rest. For individuals with bipolar disorder, this sensitivity appears to be much more intense. Bipolar disorder has an extreme correlation with sleep disturbances of all kinds:
- Lack of sleep and insomnia accompany manic episodes, while increased sleep marks depressive episodes (Kanady et al., 2015).
- Sleep deprivation is also a known trigger for major mood episodes (Cordeiro et al., 2023).
- In addition, sleep disturbance can predict some of the more serious risks of the condition, including a propensity toward suicide (Benard et al., 2019).
Circadian Rhythm
Disruptions in circadian rhythm are also common in bipolar disorder, even compared to other mood disorders like major depression (Takaesu, 2018). Research has sought to understand the relationship between circadian rhythm and bipolar disorder.
While the genetics of bipolar disorder are mysterious, several genetic markers have been explored for the condition. The same can be said for differentiations in circadian rhythm.
Playfully called "clock genes," many genetic markers and expressions have been connected to our natural sleep-wake rhythms. There may be a biological reason why some of us are naturally night people while others are early birds.
The research is complex. However, expression of at least four "clock genes" — ARNTL, ARNTL2, BHLHE41, and CIART — were found to correlate with a diagnosis of bipolar disorder in a sample of 57 individuals, 20 with bipolar disorder and 37 without (Courtin et al., 2023).
A Treatment Target
Regulation of sleep patterns through behavioral, interpersonal, and psychiatric interventions is a potential treatment target for individuals with bipolar disorder. In particular, interpersonal and social rhythm therapy (IPSRT) is a therapy modality that focuses on stabilizing sleep and social rhythms through monitoring, implementation of sleep hygiene practices, and interpersonal interventions.
IPSRT has effectively improved mood symptoms and social functioning in individuals with bipolar disorder (Steardo et al., 2020). It has also been studied as a preventative intervention for adolescents at high risk for the condition due to family history (Goldenstein et al., 2018).
While research is still in progress, sleep disturbance appears to have some role in bipolar disorder. There is potentially a genetic basis for this; for individuals with bipolar disorder, stable sleep rhythms are essential to wellness. For those struggling, psychotherapies such as ISPRT are available to help.
To find a therapist, visit the Psychology Today Therapy Directory.
References
Benard, V., Etain, B., Vaiva, G., Boudebesse, C., Yeim, S., Benizri, C., & Geoffroy, P. A. (2019). Sleep and circadian rhythms as possible trait markers of suicide attempt in bipolar disorders: an actigraphy study. Journal of affective disorders, 244, 1-8.
Cordeiro, C. R., Côrte-Real, B. R., de Carvalho Saraiva, R. A. P., Frey, B. N., Kapczinski, F., & Cardoso, T. A. (2023). Triggers for acute mood episodes in bipolar disorder: A systematic review. Journal of Psychiatric Research.
Courtin, C., Marie-Claire, C., Gross, G., Hennion, V., Mundwiller, E., Guégan, J., & Etain, B. (2023). Gene expression of circadian genes and CIART in bipolar disorder: A preliminary case-control study. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 122, 110691.
Goldstein, T. R., Merranko, J., Krantz, M., Garcia, M., Franzen, P., Levenson, J., ... & Frank, E. (2018). Early intervention for adolescents at-risk for bipolar disorder: A pilot randomized trial of Interpersonal and Social Rhythm Therapy (IPSRT). Journal of affective disorders, 235, 348-356.
Kanady, J. C., Soehnera, A. M., & Harvey, A. G. (2015). A retrospective examination of sleep disturbance across the course of bipolar disorder. Journal of sleep disorders & therapy, 4(2).
Santosa, C. M., Strong, C. M., Nowakowska, C., Wang, P. W., Rennicke, C. M., & Ketter, T. A. (2007). Enhanced creativity in bipolar disorder patients: A controlled study. Journal of affective disorders, 100(1-3), 31-39.
Steardo, L., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F., & Fiorillo, A. (2020). Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial. Annals of general psychiatry, 19(1), 1-7.
Takaesu, Y. (2018). Circadian rhythm in bipolar disorder: a review of the literature. Psychiatry and clinical neurosciences, 72(9), 673-682.
