Ask The Doctor: Why Sleep Is Essential For Bipolar Stability

Last Updated: 28 Jun 2019

Without restorative sleep, life is tough for anyone. Managing sleep is the absolute number-one priority in the ongoing maintenance of bipolar disorder.

Most of us find stability in the predictable patterns of our daily lives. We begin our work, our studies, or our household tasks according to a routine: the children want breakfast, the dog needs to be walked, it’s time to leave for / return from our job or school, make dinner, etc. A major—and I am talking major—part of the daily routine is sleep.

Why is sleep important?

Without sleep, life is tough. Concentration is poor, attention is compromised, and our ability for logical judgment is off. While we are asleep, our body restores depleted energy. Similarly, our brain rejuvenates. Glycogen, a complex sugar and energy reserve, is built up. Our overall metabolism is reduced, allowing for the removal of metabolic by-products from cells. Certain hormones are preferentially released during sleep, especially those that promote growth, repair, and replacement of cellular elements. Growth hormone is released. A healthy immune system appears to be dependent, at least in part, on sleep.

There is incredible science around sleep: its phases, timing, and quality. It is universally accepted that poor sleep is not good—at every level of both physical and mental health.

Is sleep a bigger deal for people with bipolar?

People with bipolar disorder are particularly susceptible to sleep issues. A very common first sign of mania is decreased or even total loss of sleep and the perception that one does not need sleep. An amazing feeling of energy and brilliance in the context of little sleep is deceptively intoxicating and exhilarating; ideas spark throughout the night and the brain does not seem to be able to slow down, let alone sleep.

Depression, on the other hand, often presents as overwhelming fatigue and a need for excessive sleep. Restorative sleep seems to disappear, and an affected individual may feel totally unrested after sleeping, or there may be broken and disrupted sleep.

Because sleep is such a major issue in bipolar disorder, a healthy sleep pattern is one of the hallmarks of successful wellness management.

How can I get the good night’s sleep that my body and mind need?

The first order of business is routine, routine, routine. It is very difficult to sustain a healthy sleep pattern in chaos. Set a schedule and stick to it.

Consult with your treatment team. Keep a sleep diary: Every morning, record the approximate number of hours you slept. Show it to your health-care provider to get a perspective on your sleep patterns. If warranted, ask for a referral to a sleep specialist. Are there health-related issues that come into play, such as snoring or sleep apnea? What about diet and caffeine, alcohol, or stimulants? Is your activity level in the evening appropriate? Do you have a routine to wind down and prepare the body and brain for resting mode? What about a mindfulness approach to sleep (relaxation techniques)? Do you need a medication that helps with sleep? How much computer / cell phone screen time are you subjecting yourself to before bed (or worse, in the middle of the night)? The nature of light coming from electronic screens, much of which is in the “blue” range, appears to have stimulatory effects, and there has been a lot of buzz lately about the ability of blue-filter glasses to augment the treatment of bipolar mania. As can be deduced from this series of questions, there are many approaches that can be used to address and begin to manage sleep issues.

I believe that the management of sleep is the absolute number-one priority in the ongoing maintenance of bipolar disorder. With awareness and discipline, you can improve your sleep hygiene for better overall health in both body and mind.

Printed as “Sleep––More Than Just a Body at Rest,” Summer 2019

About the author
Melvin G. McInnis, MD, FRCPsych, is Thomas B. and Nancy Upjohn Woodworth Professor of Bipolar Disorder and Depression and professor of psychiatry in the Department of Psychiatry, University of Michigan School of Medicine. He is also principal investigator of the Heinz C. Prechter Bipolar Research Program and associate director of the University of Michigan Depression Center.
  1. For roughly ten years I experienced chronic insomnia. I managed it by laying in bed, listening to soothing music. I felt peaceful and calm, drifting in and out of sleep throughout the night. In the morning I felt fine- not the least bit tired. The pattern of my moods was three months of low grade depression followed by three months of mild mania. During all of this time I was not medicated.
    After I did go on medication the insomnia disappeared.
    It’s tempting, though, to stay up late because as the day goes by my mood steadily improves, and by nighttime I actually feel ‘’ normal ‘’- no low mood or elevated mood.

  2. My daughter works the night shift and has so much trouble with her ability to stay asleep. She wakes up after only 2 or 3 hours of sleep. I’m really worried about her. Is there anything you can suggest that might be helpful to her?

  3. Where can you get / buy blue filter glasses ??? i would like to know it might help my husband , with his racing thoughts .thank you Mai

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