Sleep disturbance in euthymic bipolar patients

Abstract

Objective Sleep disturbance is a common feature during mood episodes in bipolar disorder. The aim of this study was to investigate the prevalence of such symptoms among euthymic bipolar patients, and their association with risk for mood episode recurrence. Method A cohort of bipolar I and II subjects participating in the Systematic Treatment Enhancement Program for Bipolar Disorder who were euthymic for at least eight weeks were included in this analysis. Survival analysis was used to examine the association between sleep disturbance on the Montgomery-Asberg Depression Rating Scale (MADRS) and recurrence risk. Results 73/483 bipolar I and II subjects reported at least mild sleep disturbance (MADRS sleep item ≥ 2) for the week prior to study entry. The presence of sleep problems was associated with a history of psychosis, number of previous suicide attempts, and anticonvulsant use. Sleep disturbance at study entry was significantly associated with risk for mood episode recurrence. Conclusions Sleep disturbance is not uncommon between episodes for individuals with bipolar disorder and may be associated with a more severe course of illness. This suggests that sleep disturbance is an important prodromal symptom of bipolar disorder and should be considered a target for pharmacologic or psychosocial maintenance treatment.

Evidence for cognitive subgroups in bipolar disorder and the influence of subclinical depression and sleep disturbances

“…Sleep disorders have a high prevalence in euthymic BP. According to the literature, 15-60% of remitted BP show a delayed sleep onset and reduced sleep time, examined by self-report and actigraphy (Brill et al, 2011;Giglio et al, 2009;Sylvia et al, 2012). Moreover, recent research demonstrated that BD is highly associated with sleep and circadian rhythm abnormalities (Murray and Harvey, 2010;Scott, 2011).…”

Interventions for Sleep Disturbance in Bipolar Disorder

“…During episodes of depression, insomnia or hypersomnia are common. Even in the inter-episode period, sleep is disturbed; up to 70% of bipolar disorder patients report insomnia 8 , which is associated with risk for relapse and suicide attempts 9 . Hypersomnia is experienced by roughly 25% of bipolar 1 patients during the inter-episode period 10 and by 40–80% during episodes of depression 11 .…”

Associations between circadian rhythm instability, appraisal style and mood in bipolar disorder

“…Prospective relationships between CR disruption and bipolar mood episodes have been reported (Jackson et al, 2003;Murray, 2006;Proudfoot et al, 2011), as well as CR disturbance during euthymia (Gershon et al, 2012;Saunders et al, 2013;Sylvia et al, 2012).…”