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Bipolar Disorder

Sleep and Bipolar Disorder: A Rocky Relationship

Personal Perspective: Proper sleep is essential for mood stability.

Key points

  • Sleep disturbance is a defining feature of bipolar disorder.
  • Mania is characterized by a decreased need for sleep, while depression often causes prolonged sleeping.
  • A healthy sleep cycle is necessary for bipolar recovery, and should be treated as a priority.

I was on the brink of snapping at my boyfriend this morning, because his mattress app scolded me that I’d overslept. This opinionated mattress is one of those fancy jobs that hooks up via Bluetooth to your phone and measures all sorts of things you didn’t even know you had, like HRV (heart rate variability). I’d been in bed for a little over 9 hours, and the app took it upon itself to warn me that, “Too much sleep can be a bad thing, so try not to make it a habit.”

I showed the text to my boyfriend, thinking we would share a laugh about it. Instead, he said, “Sweetie, sleep is that company’s whole business. They must know what they’re talking about.”

He obviously forgot that I’m bipolar. And that I’ve written three books about the subject. And that if there’s one thing I feel like I’m a semi-expert on by virtue of my illness, it’s the subject of sleep.

Sleep disturbance is considered a defining feature of bipolar disorder in all its phases (Harvey, A., American Journal of Psychiatry. 2008 July; 165(7):820-9). A severely decreased need for sleep is one of the most common symptoms of mania, while depression is often characterized by hypersomnia (sleeping for very long periods). It’s possible that sleep issues are so common among bipolar individuals because of a biological vulnerability—i.e., a genetic abnormality in their circadian rhythm system (Wehr, et al., American Journal of Psychiatry. 1987; 144:201–204).

I didn’t always understand this the way I do now. For most of my life, I just thought I didn’t know how to sleep like a normal person. Was it something they taught you in nursery school that I had somehow missed? I remember looking around at all the other kids during nap times, wondering how they managed to drift off into dreamland upon the teacher’s command, while I was still tossing and turning and fretting about being awake.

Sleep either evaded me completely or drowned me into unconsciousness, depending on what mood state I was in at the time. In periods of hypomania, I would feel a heightened sense of wakefulness—an acute alertness to sounds and stimuli I usually overlooked. I was like a dog let loose for a romp, and the world was one big joyous wonderland of sensory input known only to me.

But once that hypomania escalated into full-blown mania, the input overwhelmed me. There was no escaping it—too much light, too much noise, too much tactile information; I couldn’t tune it out for a millisecond. If I tried to close my eyes against the searing brightness, they’d only flutter open again. It was pointless even to try to sleep, so I’d spend days whirling around in a manic spin, my body exhausted but my mind cruelly, savagely awake.

One would think the inevitable ensuing depression would come as a relief, but it didn’t. Depression is never welcome, no matter how much one longs for mania to end. True, my world would slow way down then, but the slowness came at an unbearable price: an intense paralysis of thought and action. The lethargy seeped into my very bones until it became nearly impossible for me to do anything but lie motionless in my bed. Sleep became my only escape, and I’d spend days, even weeks, trapped under my covers, haunted by the memory of movement.

Thank God, those too-awake days and nightmare-soaked nights are mostly behind me now. Medication, therapy, mindfulness, and years of education have rewarded me with mood stability. But even though I’m now what’s called “euthymic”—meaning my bipolar symptoms are in remission—sleep remains an absolute priority in my life. I know that it’s one of the linchpins of my recovery, and that I could easily backslide if I don’t care for it the way I would care for a treasured possession.

That’s why I guard it so fiercely. As I emphatically told my poor boyfriend this morning, nobody and nothing—and certainly not a mattress app!—gets between me and a good night’s sleep. The truth is, bipolar disorder often makes me feel like my mind is not my own. Sleep is one of those rare things that gives me a modicum of control. It would be foolhardy not to treat it like the precious resource it is.

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