The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls

Abstract

Sleep is highly altered during affective episodes in patients with bipolar disorder. There is accumulating evidence that sleep is also altered in euthymic states. A deficit in sleep regulation may be a vulnerability factor with aetiological relevance in the development of the disease. This study aims to explore the objective, subjective and lifetime sleep characteristics of patients with manifest bipolar disorder and persons with an elevated risk of developing the disease. Twenty-two patients with bipolar I and II disorder, nine persons with an elevated risk of developing the disorder and 28 healthy controls were evaluated with a structured interview to characterize subjective and lifetime sleeping habits. In addition, participants wore an actimeter for six nights. Patients with bipolar disorder had longer sleep latency and duration compared with healthy controls as determined by actigraphy. The subjective and lifetime sleep characteristics of bipolar patients differed significantly from healthy controls. The results of participants with an elevated risk of developing the disorder had subjective and lifetime characteristics that were largely analogous to those of patients with manifest bipolar disorder. In particular, both groups described recurring insomnia and hypersomnia, sensitivity to shifts in circadian rhythm, difficulties awakening and prolonged sleep latency. This study provides further evidence that sleep and circadian timing are profoundly altered in patients with bipolar disorder. It may also tentatively suggest that sleep may be altered prior to the first manic episode in subjects at high risk.

Sleep-Wake Patterns of Adolescents with Borderline Personality Disorder and Bipolar Disorder

“…This result is in agreement with a previous report showing that euthymic BD youths (n = 13; all on mood stabilisers and/ or antidepressants and none taking stimulants or hypnotics during data collection) slept longer than ADHD (n = 14; three patients with antidepressants and none with stimulants or hypnotics during data collection) and healthy youths (n = 21) according to actigraphic recordings [50]. Longer sleep duration has also been reported in previous actigraphy studies using euthymic BD adults [19,20,70,71].…”

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

“…We observed similar levels of sleep disturbance in individuals with BD compared to individuals at BHR, corroborating existing findings (Ritter et al, 2012). The two groups were also similar regarding positive, internal appraisal styles, and differed significantly from the non-clinical controls.…”

“…Non-clinical controls exhibited significantly better sleep quality than other participants, corroborating existing evidence of poorer subjective sleep quality in individuals with BD (Harvey et al, 2005;Millar et al, 2004;Ritter et al, 2012;Talbot et al, 2012), BHR individuals (Ritter et al, 2012), and individuals with fibromyalgia (Osorio et al, 2006;Theadom and Cropley, 2008). We observed similar levels of sleep disturbance in individuals with BD compared to individuals at BHR, corroborating existing findings (Ritter et al, 2012).…”

Variants in Ion Channel Genes Link Phenotypic Features of Bipolar Illness to Specific Neurobiological Process Domains

“…Sleep disturbances, including an increased or a decreased need for sleep, an altered sleep/wake cycle, an altered REM onset latency, and difficulty falling asleep are seen not only during mood episodes but also during the euthymic state [119,120]; such changes are also found in those who are at high risk of developing BD [121]. Increased cholinergic sensitivity and REM density were noticed in remitted bipolar patients in response to the cholinergic drug arecoline [122].…”