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Sleep in bipolar disorder
Psychologystudent79: Current research directions and findings regarding the role of sleep in bipolar disorder.
Sleep is known to play an important role in the [[etiology]] and maintenance of a [[bipolar disorder]] <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. Patients with a bipolar disorder often have for example a less stable and more variable [[Circadian rhythm|circadian]] activity. This circadian activity disruption is often also apparent, even if the person concerned isn't currently ill <ref>Liquid error: wrong number of arguments (1 for 2)</ref>.
A decreased need for sleep is a symptom of both a [[manic episode]] and a [[hypomanic episode]] <ref>Liquid error: wrong number of arguments (1 for 2)</ref> in bipolar disorder. Sleep disturbances are also very often also a [[prodrome]] for the onset of a manic, hypomanic or depressive episode <ref>Liquid error: wrong number of arguments (1 for 2)</ref> <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. Current Research on circadian and sleep-wake processes showed that they play an important role in the etiology and maintanance of a bipolar disorder<ref>Liquid error: wrong number of arguments (1 for 2)</ref>.Previous studies showed, that the circadian system can modulate the current mood state with positive affect <ref name=":0">Liquid error: wrong number of arguments (1 for 2)</ref>. When being challenged on the other hand, it can also have negative consequences on the mood <ref>Liquid error: wrong number of arguments (1 for 2)</ref>.
The social [[zeitgeber]] hypothesis therefore proposes, that in bipolar disorder the fundamental circadian instability can be moderated by the stabilization of of daily rhythms and zeitgeber <ref name=":1">Liquid error: wrong number of arguments (1 for 2)</ref>. According to the hypothesis a disruption (e.g. life events) could trigger depressive, hypomanic or manic episodes. A regular daily rhythm on the other hand can have a positive effect and lead to a normalization of the circadian system. The goal of treatment programs like the interpersonal and social rhythm therapy therefore is to regulate the social rhythms of a patient and thereby normalize the biological rhythms <ref name=":1" />.
REM sleep in bipolar disorder
Current research on REM sleep found, that [[REM sleep]] is critical in the processing of episodic emotional memories <ref name=":2">Liquid error: wrong number of arguments (1 for 2)</ref>. When the REM sleep activity in patients with a unipolar or bipolar depression were measured, often an increased REM density was found <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. The increased REM density in unipolar and bipolar depression might have two implications. First, it could represent a failed attempt to depotentiate negative emotional experiences during the sleep <ref name=":2" />. Another possible implication is that the increased REM density may pathologically reinforce negative self-narratives and maintain negative moods after sleeping <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. Both hypothesis are not yet fully proven but show the importance of sleep and sleep disruptions in bipolar disorder and the need for further research.
Sleep disorders and bipolar disorder
The diagnosis of a bipolar disorder is linked to various sleep disorders <ref></ref>. Mainly it is very comorbid with [[Insomnia]] and [[Hypersomnia]] <ref name=":3">Liquid error: wrong number of arguments (1 for 2)</ref>. Other related sleep disturbances are for e.g. a [[Delayed sleep-phase syndrome|delayed sleep phase syndrome]], [[Circadian rhythm sleep disorder|circadian-rhythm sleep disorder]], [[Sleep apnea|sleep apenea]], REM sleep abnormalities and Irregular sleep-wake schedules <ref name=":3" />.
The bipolar disorder is also linked with higher rates of suicidal ideating and suicidal attempts <ref>Liquid error: wrong number of arguments (1 for 2)</ref><ref>Liquid error: wrong number of arguments (1 for 2)</ref>. It has been shown, that sleep disturbances can have an influence on the [[suicidality]] of patients with a bipolar disorder <ref name=":4">Liquid error: wrong number of arguments (1 for 2)</ref>. One study found, that poor sleep quality and nightmares can increase the risk for suicidal ideation and suicidal attempts <ref name=":4" />.
Genetic vulnerability
The bipolar disorder is known to have a high [[heritability]] <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. Therefore sleep disturbances in bipolar disorder could also have a genetic basis. Studies found modest associations between several genes that are known to be associated with the generation and regulation of circadian rhythms and bipolar disorder <ref name=":5">Liquid error: wrong number of arguments (1 for 2)</ref>. Two locus interactions between sleep disturbances of the rs11824092 (ARNTL) and rs11932595 (CLOCK) were found in one study <ref>Liquid error: wrong number of arguments (1 for 2)</ref>.
Sleep disturbances & relapse
Sleep disturbances in bipolar disorder are also be an important marker for [[relapse]]. Multiple studies found evidence, that sleep disturbances contribute to relapse <ref name=":5" />. Sleep disturbances are the most common prodrome of a manic episode and the sixth most common prodrome of a depressive episode <ref name=":5" />.
Sleep disturbance as a residual symptom of a bipolar disorder
Sleep disturbance is not only associated with the onset of of manic or hypomanic episodes but also displays a residual symptom of manic and depressive episodes <ref name=":5" />. They are associated with residual depressive symptoms and perceived cognitive performance and can thereby negatively influence the functioning and recovery of a patient <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. This is one reason why therapy programs like the Interpersonal and social rhythm therapy aim to reduce sleep disturbances <ref name=":6">Liquid error: wrong number of arguments (1 for 2)</ref>.
Treatment possibilities regarding the sleep disturbances in bipolar disorder
[[Interpersonal and social rhythm therapy]] (IPSRT)
A main goal of the IPSRT is is to regulate both circadian rhythms and sleep–wake cycles <ref name=":6" />. To acieve this goal maintaining regular daily rhythms in for e.g. exercise, eating, sleeping and waking are central in the IPSRT. Research has shown, that the sleep-wake cycle (circadian rhythms and sleep) can be moderated by social and volitional factors <ref name=":0" />. Based on this chronobiological model IPSRT aims to manage the possible chaos of bipolar disorder symptomatology <ref name=":6" />.
[[Light therapy]] for bipolar disorder
A recent study is also suggesting, that the bipolar disorder is linked with an enhanced sensitivity to light <ref name=":7">Liquid error: wrong number of arguments (1 for 2)</ref>. In the study four of the five women who received a midday light session responded well. Three of the four who received light in the morning developed a mixed state, and the other responded well. The authors conclude that light therapy is possibly an effective augmentation strategy in the treatment of the bipolar disorder <ref name=":7" />.
Total or partial sleep deprivation
Anonther proposed treatment for sleep disturbances is total or partial [[sleep deprivation]]. Total or partial sleep deprivation has been found to induce an increased mood in depressed bipolar patients <ref name=":5" />. Problematically depressive symptoms often seem to return soon after the patient has slept. Two theories hypothesize, that circardian mechanisms might the reason <ref name=":5" />.
According to the internal coincidence model, depressed patients are not sleeping at the right biological clock time because the phase angle between the sleep-wake cycle and the biological clock is out of alignment <ref>Liquid error: wrong number of arguments (1 for 2)</ref>. Based on this theory sleep deprivation works at first because it prevents sleep at the critical phase but in recovery sleep, the misalignment is reinstated.
In the two process model of sleep, it has ben proposed, that depression is characterized by a deficiency in the building up of [[process S]] <ref name=":8">Liquid error: wrong number of arguments (1 for 2)</ref>. Therefore, sleep deprivation might increase process S in the beginning, but a relapse occurs, when sleep deprivations isn't applied anymore and process S returns to a low level <ref name=":8" />.
July 08, 2019 at 06:55PM
