I just read The Borrowed Life of Frederick Fife. Have you read it?
Such a fun and heartwarming novel. It was written by Anna Johnston, a physician who worked in a nursing home, and was inspired by her grandparents.
I won’t spoil it, but I loved the above quote on sleep.
Sleep disturbances are a core feature of many medical conditions, including bipolar disorder.
It’s the “S” in the DIGFAST mnemonic for mania.*
Sleep issues in bipolar disorder aren’t limited to acute episodes of mania, hypomania, or depression.
You can also see persistent sleep issues during euthymic (interepisode) periods, showing up in a variety of ways, including chronic insomnia, hypersomnia, or irregular sleep-wake patterns.
Circadian rhythm disturbances, including delayed sleep phase, are also common, and are associated with greater mood instability and functional impairment.
That’s why stabilizing sleep is a key preventive strategy in bipolar disorder.
This week, I have a video for you that’s a little different.
It’s an interview with Bill Fitzgerald, also known as The Accidental Life Coach, and a patient with bipolar disorder in Ireland.
He shares his raw and inspiring journey of living with bipolar disorder and trauma, overcoming chronic insomnia, and rebuilding his life from the inside out.
Bill and I share an Irish connection, as we’re both UCC (University College Cork)alums – I went to med school in Cork, Ireland.
Here are some tips to get you started:
During mania or hypomania, the hallmark sleep change is a reduced need for sleep (not insomnia). People sleep significantly less without feeling tired.
During depression, you can see insomnia or hypersomnia. Hypersomnia is more common in bipolar depression than in unipolar depression. That’s a diagnostic pearl most people miss.
PSG (polysomnogram) and actigraphy show increased sleep onset latency (time to fall asleep) and increased REM density across all illness stages.
We also see more obstructive sleep apnea, restless leg syndrome in people with bipolar disorder…yet these may go undiagnosed.
Sleep changes are often early warning signs.
Trouble falling asleep or sleeping too much can show up weeks to months before a depressive episode.
Decreased need for sleep often precedes mania.
If you’re treating bipolar disorder, or managing it yourself or with a loved one, addressing sleep is vital.
It’s one of the most powerful tools we have for preventing relapse and protecting stability.
To see what that looks like in real life, listen to Bill’s story here.
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P.S. DIGFAST is a mnemonic to remember the symptoms of mania. It stands for: Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity increased, Sleep decreased, and Talkativeness
References:
1. Kaplan KA. Sleep and sleep treatments in bipolar disorder. Curr Opin Psychol. 2020 Aug;34:117-122. doi: 10.1016/j.copsyc.2020.02.001. Epub 2020 Feb 13. PMID: 32203912.
2. Lewis KJS, Richards A, Karlsson R, et al. Comparison of Genetic Liability for Sleep Traits Among Individuals With Bipolar Disorder I or II and Control Participants. JAMA Psychiatry. 2020;77(3):303–310. doi:10.1001/jamapsychiatry.2019.4079
3. Palagini L, Miniati M, Caruso D, Massa L, Novi M, Pardini F, Salarpi G, Pini S, Marazziti D, Etain B, Riemann D. Association between affective temperaments and mood features in bipolar disorder II: The role of insomnia and chronobiological rhythms desynchronization. J Affect Disord. 2020 Apr 1;266:263-272. doi: 10.1016/j.jad.2020.01.134. Epub 2020 Jan 22. PMID: 32056887.
