University Life, Bipolar Disorder and Inadequate Sleep: A Risky Combination

The challenges of getting adaquate sleep for the bipolar university student

Posted Sep 12, 2010

One of the big differences between living at home versus being away at college is that no one is going to say anything about your sleep habits, except maybe a roommate who you might be keeping up when he or she is trying to sleep. In most respects, your daily life patterns are now your own to determine. And this is no small thing when you think about how long that hasn't been the case.

For those who are not bipolar, this is a welcome progression. But for those with bipolar disorder who are also attending college for the first time, your newfound freedom can also translate into newfound danger. And yet the freedom to just do what you want at any hour can also be very enticing. After all, think of the literally hundreds (perhaps thousands) of times parents have said something about not staying up too late. But now at 1:00 AM if friends say, hey let's go get a pizza, there's nothing stopping you from saying, sure! And except for feeling a bit dragged out when you try to wake up for your 9:00 o'clock class, you think what's the big deal? It's only pizza.

Well actually, it's only your stability.

You see, sleep is pivotal to stability if you have bipolar disorder. For those who are bipolar and experiencing mid-range mood (not up or down), inadequate sleep can become a precipitant of hypomanic (mild manic) symptoms, especially when paired with the multitude of other stresses inherent to college life. Time and again I'll see bipolar students who disregard the necessity for good sleep, and sure enough when they string together two or three nights in a row with only 4 or 5 hours sleep they begin to destabilize. Their hold on mid-range slips away and they're on their way towards hypomania or worse.

The same can also happen in reverse order. That is, when non-sleep related stress causes an elevated mood state, then decreased need for sleep becomes one of the indications that someone is possibly bipolar.

Just last week a student was telling me about his last manic episode that spanned the second half of spring semester. He could go for two or three full days without any sleep, get about 6 to 8 hours on the third night and then continue on without sleep for another couple of days. And all the while, he barely felt fatigued. Now this might sound somewhat appealing for those of us who feel so dependent upon our nightly sleep, but this student's reality was that throughout the latter part of his last semester in school, he had little control over much of his life.

Adequate and consistent sleep helps establish that which we refer to as our circadian rhythms. I write about this in my recent book: "These are the body's recurrent rhythms of alertness, energy, activity, fatigue, and sleep corresponding to the 24 hours of the earth's daily rotation. For most people who are not bipolar these rhythms remain fairly constant. But for the bipolar person, when he or she is under stress, these rhythms easily go awry.

If you're depressed, you may find that it's difficult to wake up in the morning. You may also find yourself going back to sleep at different times during the day. Without the "on" switch of energy and alertness, your body is lacking what it needs to move forward.

In episodes of hypomania and mania, just the opposite occurs. Your heightened energy doesn't naturally slow down toward the end of the day. Your acceleration remains "on" and the natural cues of nighttime darkness don't prompt the drowsiness that then progresses toward sleep. Even when exhaustion finally does take you into sleep, you may find you awaken only a few hours later with your accelerator still pressed to the floor. What makes this all worse is that you can't seem to find the switch to turn it all off.

The point is that too much or too little sleep can have profound impact on mood and energy, especially if you're bipolar." *

OK - so healthy sleep is really important if you're bipolar. Not too much ... not too little... just enough. And how do you get there, especially if you're relishing the freedom of living your own life away from parental oversight? You work at it, like it's just as important as any other part of your health. You probably wouldn't drink out of a friend's glass if you knew she had the flu. Similarly, do you really want to mess with your sleep if you know that doing so can cause you to become unstable?

Living well with bipolar disorder requires this degree of commitment and restraint. I won't pretend it's easy. In fact, I have a lot of admiration for those who do it well. It won't serve as insurance against instability, but it will certainly provide you with a more stable foundation in order to withstand the impact of all the other things in life that can potentially throw you off balance.

* quote from chapter 4: Federman, R and Thomson, J.A. 2010. Facing Bipolar: The Young Adults Guide to Dealing with Bipolar Disorder. Oakland: New Harbinger Publishers

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Russ Federman is Director of Counseling and Psychological Services at the University of Virginia. He is also co-author of Facing Bipolar: The Young Adult's Guide to Dealing with Bipolar (New Harbinger Publications), see