Debilitating by itself, insomnia compounds other aspects of bipolar disorder. Lack of sleep wears down resistance and makes a person with bipolar disorder prone to the other symptoms of mania: poor judgment, mood lability, irritability and impulsivity. Because of their already altered brain chemistry, people with bipolar disorder, when robbed of sleep, can become psychotic.
Bipolar characteristics
The bipolar person tends to swing from one extreme to the opposite. "Current Medical Diagnosis and Treatment, 2010" explains: When in the "manic phase" of the illness, the patient appears energetic, enthusiastic and hyper-motivated. He has trouble staying focused and his thoughts take flight. He needs little or no sleep or feels anxious because he can't go to sleep. He talks incessantly and very fast. Sometimes the mania takes the form of anger and irritability. A common thread, poor or impaired judgment, manifests itself in overspending, hypersexuality, spontaneous quitting of a job, and reckless or dangerous behavior such as drinking, taking illegal drugs, speeding, driving while impaired and other behavior that endangers his life and the lives of others. On the flip side, when the manic phase ends, he crashes, runs out of steam, becomes depressed, feels shame and guilt over his actions, and sleeps excessively both to make up for lost sleep and as an escape mechanism from manic actions.
Insomnia and bipolar disorder
When manic, the person with bipolar disorder suffers from insomnia. When depressed, she experiences hypersomnia, the need to sleep excessively, according to Medscape.com, 2004. Without sleep, she moves further from reality and displays irrational and unpredictable behavior. "Current Medical Diagnosis and Treatment, 2010" states that such a patient may graduate to having grand delusions, auditory hallucinations and severe paranoia.
Insomnia treatment
Sleep aids such as prescription Ambien and Lunesta make little difference in light of the powerful effects of this illness. The bipolar patient has insomnia because his brain revs up during mania. The best sleep medicines will likely fail in this part of his cyclic illness. Management of the disorder, the most direct approach, gives him the best chance of overcoming the insomnia. A psychiatrist implements a two-medication treatment. The drug of choice for bipolar disorder, lithium, controls the rapid and extreme shifts in mood. Other options include Depakote and Seroquel. For the depressive part of the illness, anti-depressants such as Prozac, Zoloft, Cymbalta and Wellbutrin give good coverage.
Good sleep hygiene
Outside the realm of chemical helps, sleep hygienic patterns contribute to a more successful and restful sleep. The University of Maryland Medical Center offers the following suggestions: Avoid or reduce intake of alcohol, caffeine, sugar and nicotine, and do not eat spicy or heavy foods for four to six hours before bedtime. Instead of working or watching exciting TV right up until bedtime, spend some time reading non-news magazines or books, and enjoy a warm cup of milk. Keep the bedroom temperature cool. Practice relaxation and deep breathing exercises in bed. Turn off all lights, and mask the LED readings of clocks and phones. Consistent bedtime and wake-up time play an important role in the circadian rhythm, the natural sleep/wake cycle. Sleep for seven to nine hours a night. If you find yourself trying to fall asleep to no avail, get up, have a light snack, and read for about 20 minutes before returning to bed.
Other recommendations
The person with bipolar disorder must take charge of his illness. This means taking prescribed medicines regularly and complying with doctor's orders. Alcohol not only exacerbates bipolar symptoms, it causes insomnia and disrupts the GI tract when taken with these medicines. Overcoming bipolar insomnia takes consistency, patience and motivation. The mood-stabilizing drugs have stood the test of time and have helped many people. You can achieve better mental health and restorative sleep by taking them with compliance.
References
- Current Medical Diagnosis and Treatment; Stephen J. McPhee and Maxine A. Papadakis; 2010
- Medscape.com: Insomnia and Psychiatric Disorders; 2004
- University of Maryland Medical Center: Sleep Disorders and Sleep Hygiene; 2010
- Psychiatric Times: Circadian Rhythm in Rapid-Cycling Bipolar Disorder; 1996
