Sleep and circadian rhythms in children and adolescents with bipolar disorder

Abstract

The aim of this paper is to highlight the importance of the sleep-wake cycle in children and adolescents with bipolar disorder. After presenting an overview of the measurement and function of human sleep, we describe changes in sleep and circadian functioning across the life cycle. We then review evidence that, in adults, sleep and/or circadian rhythms are of considerable influence in the multifactorial causal chain implicated in relapse in bipolar disorder, discussing relevant mechanisms. The latter include abnormalities in the amount and timing of sleep, the role of social zeitgebers, and the importance of sleep in regulating emotional responses and mood. We next present preliminary data indicating considerable sleep disturbance among children and adolescents with bipolar disorder. Given the considerable sleep disturbance evident among children and adolescents with bipolar disorder along with a key role for sleep in emotion regulation and learning, we conclude that sleep among children and adolescents with bipolar disorder is a critical domain for future research. An agenda for future research is presented that includes descriptive studies, investigations of causality, and treatment development research.

Positive mood and sleep disturbance in acquired mania following temporal lobe damage

“…The patient did not meet criteria for insomnia but met criteria for delayed-phase syndrome. This finding is consistent with literature suggesting that sleep disturbance is a core symptom of patients with bipolar disorder [7,14,38,39] and evidence associating sleep deprivation with the onset of mania [40]. The patient also exhibited some dysfunctional beliefs about sleep measured on the DBAS [26] and SDQ [27].…”

Assessment of circadian function in fibroblasts of patients with bipolar disorder

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][80][81][82] However, molecular evidence for altered circadian clock in bipolar disorder is still lacking. It has been reported that similar components of the clock machinery underlie rhythmic gene expression in cultured fibroblasts as in the central clock in the SCN.…”

“…3,4 Changes in rest:activity and sleep:wake cycles are among the most prominent aspects of bipolar illness during both the manic and depressed phase (see references [5][6][7] for reviews). In bipolar patients, alterations in phase, period and amplitude of circadian rhythms have been documented by measuring core temperature, hormonal secretion or actigraphy.…”

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

“…23 A variety of sleep disturbances have been associated with symptoms of mood disorders among youth. 152,173,174 One study showed that depressed adolescent boys had short REM (rapid eye movement) latency and more frequent nighttime arousals, although depressed adolescent girls showed the same sleep patterns as their healthy counterparts. 175 Circadian phase shifts can occur before the onset of and during a depressive episode in adults and adolescents.…”