Sunday, December 21, 2008

Sleep and Bipolar Disorder

Sleep disturbance is a cardinal feature of bipolar disorder. During acute mania, patients exhibit markedly reduced sleep time and report a reduced need for sleep. The reduced need for sleep can be further defined as the “ability to maintain energy without sufficient sleep” (Plante and Winkelman, 2008). Even when euthymic, sleep disturbance is common (Harvey 2008). In a recent study, 55% of euthymic bipolar patients had chronic insomnia (Harvey et al 2005). Both insomnia and hypersomnia have been reported in patients with bipolar depression (Harvey 2008). Children with bipolar disorder (who often display ultradian rapid cycling rather than distinct mood episodes) exhibit reduced sleep efficiency and frequent nocturnal awakenings (Mehl et al 2006).

Both homeostatic and circadian sleep abnormalities are thought to play a role in bipolar disorder (Plante and Winkelman 2008).

Polysomnographic studies of unmedicated manic panics have found shortened total sleep time, shortened REM latency, and increased time awake in bed (Plante and Winkelman 2008).

**Harvey AG. Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. Am J Psychiatry 2008;165(7):820-9.**


Harvey AG, Schmidt DA, Scarna A, Semler CN, Goodwin GM. Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. Am J Psychiatry 2005;162(1):50-7.

Mehl RC, O’Brien LM, Jones JH, Dreisbach JK. Correlates of sleep and pediatric bipolar disorder. Sleep 2006;29(2):193-7.

**Plante DT, Winkelman JW. Sleep disturbance in bipolar disorder: therapeutic implications. Am J Psychiatry 2008;165(7):830-43.**

The above is excerpted from an article I wrote on Sleep Disorders and Mental Illness for Medlink Neurology.



10 comments:

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dysamoria said...

First:

Nice SPAM by Roop, there. Spamming a sleep blog with xanax sales URLs... Pushing the agenda of money and sales over health. Great.

Blog owners: If you enable the "capcha" feature on your blog's commenting settings, you can cut down on spam postings.

Next: My response to the blog entry:

Bipolar is NOT as common as the endless doctors' diagnosing it would seem to suggest.

Imagine being medicated for bipolar when you don't actually have it. Imagine being given seriously dangerous medications for a condition you don't have. Those medications cause emotional instability themselves, especially if the medication is unneeded. The medications also cause severe problems with sleep (and other body issues). They can lead to reduced (or zero) amounts of SWS (slow wave sleep is the most physically restorative sleep there is. period. ignore what the hypnotic agent drug commercials say about REM sleep being the most restful because it's 100% wrong and dangerously disinformative).

"Mental" illness and sleep: Cause and effect are reversed!

This is the case very often, when dealing with topics involving the stupidly mysterious "mental" health issues. "Stupidly mysterious," meaning, it's not as mysterious as people allow themselves to believe. This includes those doing research.

The brain is part of the body. The brain and the mind are the same item. You wear out the brain, the mind becomes worn out. Easy.

Neurological structure gets changed via stimulus, including the "stimulus" of the brain being constantly exhausted.

There is a horrible discrepancy between what the masses believe about the brain and what the brain is really doing/experiencing. This includes doctors. It is frighteningly common for doctors to be more aligned with clock-punching mentality than an actual academic (and practical) orientation towards understanding the mechanics of the medicine they practice. i know nothing of this blog's author, so i do not proclaim the blog author is equally irresponsible. i DO claim that many (if not most) MDs are irresponsible. Especially PsyMDs.

i'm sorry, but there IS NO bipolar disorder in children. They're simply too underdeveloped for it to be possible.

Up to what age is the term "children" being used? If it stops at teenage (13), then bipolar is simply not an acceptable diagnosis because it's not diagnosable. The constant changes going on throughout the body during development, and the constant changes in the social environment and stimuli going on during "growing up," make this an impossible diagnosis.

Anyone diagnosing children with bipolar disorder needs to have their medical licenses revoked and parents should not hesitate to seek legal aid for malpractice, especially if they've been wrangled into medicating their child.

Bipolar is a diagnosis i have witnessed being doled out to people of all ages like candy. No joke about children and candy. This is seriously dangerous.

The people i've encountered with the diagnosis of bipolar disorder have more often been abused and/or had neurological developmental disorders (like autism, which is my bias here, since i have AS), which cause all kinds of conditions that mimic the surface features of bipolar disorder. Having mood changes is NOT enough.

i have met people with bipolar diagnoses who DO seem to fit the clinical definition. They are different from the vast number of people improperly diagnosed. The "true" bipolar cases are far rarer in number than the number of "candy diagnosis" cases where the patient DOESN'T have a clinically viable case of bipolar disorder.

More specifically on topic for this blog and the posting i'm commenting on:

Sleep disturbance and lack of SWS is a CAUSE, not AN effect, in reference to bipolar or other "quick diagnostics."

Lack of quality sleep is the cause of "moodiness." It is the cause of hyper somnolence (especially in a case where the greatest sleep debt is specifically in SWS).

Lack of SWS leads to more frustration with getting sleep and often is comorbid with increased percentages of REM sleep. It is a notable cause of "refusal to sleep" feeling of not wanting to sleep (who suffering various parasomnias has not at some points been so frustrated with their sleep as to feel a reduced desire or need to sleep?).

It is the cause of being grouchy, physically exhausted and various other body problems associated with "fatigue."

Keep it going (the lack of proper sleep) and you get depression, anxiety, immune system damage, body temperature regulation problems, appetite problems, etc.

i cannot stress enough just how dangerously backwards this all is. "Behavioral health" and physiology are not separate things. You don't get counseled into good sleep or out of autism. We need a revolution in medical care, starting at the comprehension level for the people who run the show. It starts at breaking down the foolish wall between "the body" and "the brain." Step one is the insurance companies. Or is it the doctors who have been crafting the default standard in medicine who originally got the insurance companies started in their foolish separation of brain and body??

The brain is the most important internal organ of the human animal. Maybe it should be treated as such. Maybe studies of human behavior should not be pushing the agenda of "normal" as defined by abnormal people. Maybe... just maybe... the whole system is way backwards and doctors aren't the gods that some of them would be happy to have their patients believe.

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dysamoria said...

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i'll make sure to indicate as much on mine.

i don't allow corporate spam on mine, and i don't have a vested interest in making sure that people never recover from the things that make them seek doctors and medication.

i am disgusted and i hope no one ever comes to this blog looking for information, answers or help.

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karlo said...
This comment has been removed by the author.
Andy Smith said...

Sleep loss can trigger mania AND is also a strong predictor of impending mania.
Too much sleep is a frequent symptom in bipolar depression, but all this have to be diagnosis with a neurology's doctor
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