This sleep disturbance persists into the period between episodes (the interepisode period) and may contribute to illness relapse. Reduced need for sleep and insomnia or hypersomnia are common symptoms of the manic and depressive phases of bipolar disorder. Practitioners should encourage regularity in bedtimes and rise times as a first step in treatment, and carefully monitor changes in mood and daytime sleepiness throughout the intervention. Sleep restriction and stimulus control appear to be safe and efficacious procedures for treating insomnia in patients with bipolar disorder. Two of five patients who underwent sleep restriction reported mild hypomania that was unrelated to weekly sleep duration. Total sleep time did not change for these individuals.
Two patients in a total group of 15 patients reported mild increases in hypomanic symptoms the week following instruction on stimulus control.
#SLEEP EXPERT DR FOR DSPS SLEEP DISORDER SERIES#
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. The potential for manic or hypomanic symptoms to emerge after sleep deprivation in bipolar disorder raises questions about the appropriateness of these methods for treating insomnia. Both involve short-term sleep deprivation. Stimulus control and sleep restriction are powerful, clinically useful behavioral interventions for insomnia, typically delivered as part of cognitive-behavioral therapy for insomnia (CBT-I). Sleep disturbance is common in bipolar disorder.