Sleep. I, for one, am a huge fan. I love that feeling of drifting off, right before my consciousness checks out, and I adore that well-rested feeling I have when I first open my eyes after a productively-slept night. [Those nights are becoming fewer and farther between as I age, but that's just another one of those little amusements that come from slowly leaving behind those days when anyone would call me "young lady"--except for my ancient Uncle Herbie, who calls any woman under 92 a "young lady," so I can't really count him--can I? My mother, with another of her pearls, used to say that getting old is lousy--but it's better than the alternative, and, as always, mother knows best.]
Sleep disregulation is one of the hallmark of mood disorders, and, if it's on the side of the inability to sleep, often one of its tortures.
I can recall the days--oh-so-fondly--when sleep came--early and often, like Chicagoans vote. Then, of course, the key was fighting it. Remember those college nights of coffee and No-Doz? I do--and somehow I was always asleep by 3:30 anyway, head on the book on my desk, still holding the M&Ms that were requisite for any all-nighter.
As appealing as it sounded then to just rev your motor and go, reduced need for sleep is actually bad news. For a person with bipolar, it's often one of the first signs of impending trouble, as not needing your shut-eye is a hallmark of mania.
And that seems clear enough--you can't rest, you know you're speeding up. But what is fascinating is that current research seems to indicate that the inverse is true, as well. That means that simply not sleeping enough can actually help precipitate a manic episode.
In another one of those scientific article titles that I love due to their profoundly uncreative nature, Colombo et al, in the 1999 volume of Psychiatry Research entitled (here we go) "Rate of switch from depression into mania after therapeutic sleep deprivation in bipolar depression" (pretty great, right? You might have some idea of what's coming now, no?) actually found that a small but significant percentage of bipolar people, when treated to a night of total sleep deprivation, switched into a manic episode.
Fascinating, right?
In an article entitled "Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony, and regulation" in the July 2008 issue of The American Journal of Psychiatry, Allison Harvey studied the impact of disordered mood on sleep--and, interestingly enough, the impact of sleep on disordered mood. Her model suggests that individuals with bipolar have "a bidirectional relationship between daytime affect regulation and nighttime sleep such that an escalating vicious circle of disturbance in affect regulation during the day interferes with nighttime sleep/circadian functioning, and the effects of sleep deprivation contribute to difficulty in affect regulation the following day."
So you're starting an episode, you can't sleep. And now, as if that weren't bad enough, you can't sleep?--You might be starting an episode Great, right? So now what?
Well, here's where those with bipolar need to be really proactive about taking the sleep matter into their own hands.
And it's where sleep hygiene [and I love that phrase, it makes me think of those great those fifth grade hygiene classes, but now everyone is slightly drowsy] becomes vital. My guess is that you've heard it all before--but now really stick to it. You know--use your bedroom only for sleeping, no napping, get out of bed if you can't sleep for more than 20 minutes, no TV in bed, make sure you get enough exposure to natural light.
And then there's the "when all that fails" ideas, and if you are a bipolar sufferer who knows that lack of sleep is both causative of and indicative of a manic episode, you probably need to at least look into these ideas, if you don't know something else that works for you [and I don't mean drugs or alcohol]:
1. Under your doctor's careful watch you might try melatonin, which has some research showing it can help sleep during a hypomanic episode.
2. There's something called "dark therapy" which is cautiously being recommended for those tending toward mania with difficulty sleeping. It exposes the person to complete darkness for an extended period of time, hoping that this will help reset the body's sleep/wake cycle.
3. If your doctor sees it as useful, there are a variety of sedating medications used for difficulty sleeping, especially in a pre-manic phase--benzodiazepines, anti-histamines, sedating anti-depressants. There are some downsides, but they must be weighed against how crucial it is not to set off an episode by suffering sleep deprivation.
4. There's a new therapy called Interpersonal and Social Rhythm Therapy. It's a type of psychotherapy unique to bipolar disorder, with a focus on assisting people in maintaining regulated routines, sleep included.
The Bard himself recognized that sleep is what "knits up the ravelled sleeve of care," it is "balm of hurt minds, great nature's second course, Chief nourisher in life's feast."
Without it we all start to come unravelled--when the bipolar disordered person lacks it, she is set on a dangerous course.
Candida Abrahamson is a Chicago-area mediator, counselor, and hypnotherapist with a country-wide practice via phone sessions. Find out more about Candida and her work on her website at http://candidaabrahamsonphd.com/. To read Candida's in-depth writing on a variety of topics, check out her blog at http://candidaabrahamson.wordpress.com/.
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