Sleep Disorder vs. Bipolar Disorder

April 3, 2008 at 12:47 am 16 comments

Sometimes I wonder if bipolar disorder is really an accurate diagnosis. Which seems churlish, because I spent the best part of a year trying to be diagnosed with it. And yes, there’s the depression and the hypomanic-esque episodes where I start believing things that have only a tangential connection to reality. But my problems with mood are almost inextricably linked to my problems with sleep and the problems with sleep came first.

Sleep is plenty weird as a phenomenon, not least because science has yet to come up with a convincing explantion of what exactly it’s for. All mammals do it, as do all birds. It becomes difficult to extend definitions of sleep to insects and other arthropods, but an analogous process seems to take place. Sleep is a very vulnerable state for an animal to be in. In evolutionary terms, the benefits of sleep have to be important enough to outweigh the vulnerability that a lack of consciousness causes. Everything sleeps. Sleep’s important.

I was originally supposed to be the first of a pair. Before she met my father, my mother had been through a tubal ligation. She’d had her children – my half-brother and sister. My father persuaded her to have a reversal. This was not a cheap or simple procedure back then. I guess they wanted to get their money’s worth, so they planned to have two children. But as a baby I slept so badly that my mother decided she couldn’t survive being kept awake for another two or three years.

I don’t think my sleep was ever good. I was a smart kid and I enjoyed school, but my attendence was always patchy. I don’t know for sure that this was because of sleep problems, but I guess it was. My mother tells me that when I was small, she would come into my room to check on me at 11 or 12 at night and I’d tell her that I was trying to sleep, but couldn’t. I started staying up all night before I finished primary school. This was partly out of curiosity to see if I could, and partly because of the challenge of it. I was already finding it difficult to sleep before 2 or 3 in the morning anyway, so the extra couple of hours until dawn weren’t hard to get through.

By the time I was in secondary school, I was in a state of chronic sleep deprivation. I began to find myself in a state of delirium in the mornings. Delirium is a bit like hallucinating, but it’s different, a more profound altering of consciousness. Most mornings I’d have had difficulty telling you my name. The acts of getting dressed, brushing my teeth, getting to school would have strange significances. The uniform would be armor that I had to wear because the words in my head would attach themselves to my body and drag me down, down into the mire. Hallucinations you can explain, delirium just doesn’t make any sense. I thought that this was how everyone felt when they woke up. Usually it had worn off by the time I got to school. At the weekends I was rarely awake before 11am. During school holidays I’d end up having to be woken up for lunch.

And things got worse. I know that parents often have arguments with their kids over waking up. I’d have arguments with my parents every day when they tried to wake me. I’d fall back to sleep and have no memory of having been woken up before. As the extent of my sleep-deprivation worsened, I’d refuse to get up or move at all. I’d be physically dragged out of bed by my father and fall asleep again ten minutes later.

And nobody realised that I had a problem. If I’d been growing up in a home that wasn’t quite so dysfunctional would someone have noticed and got me to a doctor? I don’t know.

My period of greatest sleep deprivation while at school coincided with my deepest depression. I doubt that this was coincidental. In my final year I missed a third of school. If I’d gone to a state school, someone would have picked up on this; at the least there’d have been serious talks about truancy. But I was at a private school and nobody knew what to do.

At 15 my parents got me a computer and we got an account with a local ISP. Through some quirk of cable TV and telephone contracts, calls to the ISP were free. This was unusual at the time and allowed me to stay up on the internet until early in the morning. This was a constant source of friction between me and my parents. They thought the internet was causing me to stay up late, so just before I turned 16 they cancelled our ISP contract. I was a miserably lonely teenager and the internet was pretty much my sole source of acceptance and positive social contact, so taking it away from me hurt. I stayed up for a full week to get my English coursework done. After I’d finished my GCSE’s they realised that I was awake anyway, whether I was on the computer or reading in my room and I was allowed back online again.

Having finished school my sleep patterns became even more chaotic. I’d met a girl on the internet. She was in America, a full five hours behind UK time. We chatted using instant messaging software and my sleep patterns lined up with hers. I got a job at the local convenience store not long after I turned 17, which plunged me into sleep-deprivation again. Sundays were the worst. I worked a split shift. I’d go into work in the morning, often having not slept. Then I’d come home, eat dinner and catch an hour or two of sleep, before my mother had to wake me up. I was better at getting up than I had been at school. At least once, my head was severely screwed up by the lack of sleep; there was a spring balance attached to the part of my mind that dealt with language and every word that was spoken to me had weight and pulled against it. I frequently had double vision and blurred vision. When I had evening shifts I’d get up just before I had to go in. On my days off, my mother would save my dinner for me so that I could heat it up whenever I got up.

Things got worse as my hours increased from part-time to full-time. With my transatlantic girlfriends, I’d be awake until 4am and have to be awake by 7am to get to work. As my mood switched to hypomanic, I’d be awake to rant weird political theories at my mum when she woke up in the mornings. One of the reasons I decided to go to university was so that I could actually get some sleep.

University was beautiful. My sleep patterns became increasingly chaotic, but with only 16 hours of lectures and seminars a week, I could usually work around them. There were occasional glitches, like the two weeks I missed everything because I couldn’t get up before my lectures had finished, but for the most part I was fine. I’d frequently stay up a couple of days at a time.

And work since then has been a nightmare, either because I was constantly in trouble through frequent lateness, or because I was forcing myself to get up no matter how tired I was. I spent pretty much all of 2006 sleeping chaotically and ending up getting an average of three hours a night. This kept my mood artificially high. Whenever I had any time off and managed to catch up on my sleep debt I’d become suicidally depressed.

The last year and a bit, since I’ve been off work have been an exception: I’ve been able to get enough sleep. For the majority of my life I’ve been in a state of chronic sleep-deprivation. Had I not had a mental illness before, I’d probably have ended up with one as a result. Consider this (from Wikipedia) for example:

Studies investigating the effects of deprivation of active sleep have shown that deprivation early in life can result in behavioral problems, permanent sleep disruption, decreased brain mass (Mirmiran et al. 1983), and an abnormal amount of neuronal cell death (Morrissey, Duntley & Anch, 2004).

There’s not much research on the long term consequences of sleep-deprivation in childhood. It’s not easy research to do since childhood sleep disorders are under-diagnosed (for example, I didn’t have a sleep disorder, I was just lazy or difficult) and longitudinal studies following sleep-disordered children are going to take years and be expensive.

Interestingly, there’s some recent research that shows that genes that control the circadian sleep cycle are linked with bipolar disorder:

“There’s evidence suggesting that circadian genes may be involved in bipolar disorder,” Colleen McClung, M.D., an assistant professor of psychiatry and the study’s senior author, told reporters at a media briefing. “What we’ve done is taken earlier findings a step further by engineering a mutant mouse model displaying an overall profile that is strikingly similar to human mania. This will give us the opportunity to study why people develop mania or bipolar disorder and how they can be treated.”

So do my genes predispose me to bipolar disorder and sleep problems, or did my sleep problems injure my developing brain and cause bipolar? Going from sleep-deprived to getting enough sleep sends me into depression. Did my sleep-deprivation as a child train my brain to need the raised levels of stress hormones in order to feel normal?

Do I have bipolar disorder or just a sleep disorder that looks a lot like it?

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Sunday into Monday Creepy Animation

16 Comments Add your own

  • 1. my sad alter ego  |  April 3, 2008 at 7:41 am

    I have wondered the same thing. I thought that the one med that really had me in a good state only did it because it was the one med that let me sleep a real, full night of ordered sleep. I thought that more than any antidepressant/calming effect, it was the letting me sleep that really fixed things.

  • 2. Syd  |  April 3, 2008 at 3:12 pm

    You pose a very interesting question, one I’ve been wondering about too. Having struggled with chronic insomnia and resulting sleep-deprivation for abou 15 years, I notice a striking correlation between the amount and quality of my sleep and my moods. Almost 2 years ago, after being diagnosed with sleep apnea, I was assured that the insomnia and the depression would go away once I was properly treated with APAP therapy. My sleep is better now, but more than the anti-depressant and the apnea machine, I think it’s the Lunesta that’s really making the difference. It’s about time that the research communities starts looking more closely at this issue.

  • 3. t  |  April 3, 2008 at 7:02 pm

    It sounds right, that sleep is the core of what ails you. When you put it in this context, it’s pretty convincing to me that sleep deprivation and its derivative stress are the anchor stars of your mental-health constellation.

    Just one minor thing that makes me wonder. Your doc prescribed you temazepam as your hypnotic, but it doesn’t seem terribly effective. And it’s a mild one anyway, as they go. How come nobody’s tried one of the newer sleep aids with you, or something more elephant-tranquilizer like? Or at least put you on the fast track for the sleep clinic?

  • 4. Alison  |  April 3, 2008 at 8:34 pm

    I’ve had sleep issues most of my life, normally going to bed late and getting up early, I am still the same now and can easily survive on 3 hours sleep in 24 hours. I appreciate sleeping at least for 3 hours since its better than tossing or turning or getting up trying to find something constructive to do. Thankfully I’ve given up walking the dog at 3am to avoid the neighbours, I actually miss that!

    The best job I had was nights, I worked 8pm till 7am 4 nights on 4 nights off at the airport I love it and spent half the time bouncing off the walls whilst everyone else I worked with was yawning the night away!

    As for if you have a sleep issue or Bipolar I really wouldn’t have a clue, perhaps both…

  • 5. experimental chimp  |  April 3, 2008 at 8:38 pm

    my sad alter ego, syd: Thanks for commenting.

    t: You underestimate the sheer amount of fear that doctors in the UK have of actually using hypnotics. It’s taken well over a year for a doctor to finally break down and prescribe a benzo for me. And even at that I was only allowed to take it continuously for two weeks before switching to once-every-other-day dosing, which is intended to manage tolerance and addiction.

    The official UK medical guidelines for treatment of severe insomnia boil down to prescribing the cheapest hypnotic at the lowest dose for the shortest time possible. The maximum length of hypnotic drug therapy allowed under the guidelines is 4 weeks.

    I’ve been to the local sleep clinic, which was run by a psychiatrist. She did not prescribe medications and did not run any tests. After she failed to help me, she referred me to a sleep clinic in London. There’s very few clinics that deal with circadian rhythm sleep disorders. There’s no such thing as the fast track unfortunately, only the very, very slow track.

    Frankly, it’s a bit of a nightmare trying to get any treatment for my sleep problems at all.

  • 6. Gabriel...  |  April 4, 2008 at 7:30 am

    Watch these, it’s a 60 Minutes piece on sleep…

    Part One [Here]

    Part Two [Here]

    Then go here:
    http://saltedlithium.wordpress.com and read the post on Sploggers…

  • 7. giannakali  |  April 8, 2008 at 12:11 am

    Well I don’t know what I have but I know I have intermittent serious sleep problems. I don’t consider myself bipolar anymore and haven’t had a mania even when I don’t sleep for days in more than 15 years. (Before revisiting my diagnosis I called a couple of sleepless periods in my life manias but there wasn’t anything manic about me except that I didn’t sleep and my doctor said I was manic…)

    I’ve thought about calling my issues a sleep disorder but it seems to me that if I take care of my body and psyche naturally that these things will right themselves. I’m learning to go natural ever so slowly…

  • 8. William  |  October 28, 2008 at 5:13 pm

    people don’t realize that most of the apnea is psychosomatic at the root cause

  • 9. advocacyandhealing  |  October 2, 2009 at 2:54 am

    My son has always struggled with sleep. When I first read that there was research that suggested that sleep disorders and bipolar disorder were related, well, it made perfect sense to me.

    Thanks for bringing this up. I hope you’ll share what works for you to help you sleep.

  • 10. Jan  |  February 20, 2010 at 3:34 am

    I hope you’ve been able to figure some of this out by now.
    I found your post because I was looking for the relationship between sleep problems and bipolar disorder, too. (I have been diagnosed with hypersomnia, and bipolar II)
    Your descripition of sleep problems even when you were very young sounds like the stories my parents told me about early years. My mother wanted to have two children who were close in age, but I was apparently such a challenge that she waited until I was before having another. She said I never napped, and that I stayed up late every night and waved goodnight to the late night television talk show hosts.
    When I was in school, waking up was always extremely difficult. I always said that the world shouldn’t begin before noon. But somehow I managed, though I often slept late on weekends, and had no difficult staying up late.
    By the time I was about 32 or so, however, I started to have a lot of difficulty staying awake at work, and staying awake once I could get home. I went to see a sleep doctor, who did a sleep test. But he initially thought he could solve my excessive daytime sleepiness with a CPAP (forced air) machine, and when several months of that provided no improvement, he just threw his hands up and had no other ideas. So, once again, I managed the best that I could, even though I had days where I would come home and sleep immediately until the alarm rang the next morning. (And I once slept from 6 pm Friday until 8 am Monday, only getting up for an hour each day to eat and go to the bathroom, so sometimes I didn’t manage very well.)
    It took me more than a decade to bother consulting another sleep doctor. This time, however, this doctor tested me both overnight, and again the next day with nap tests. At all times, it took less than 2 minutes for me to fall asleep. I registered no REM sleep during the tests. She explained that they don’t understand exactly what goes wrong, but that my brain/body is never getting the message that I’m rested after sleeping. She calls it unrefreshing sleep, which I guess is a lot like sleep deprivation over the long run.
    We have tried a few different medications since then, none of which have provided any help. Apparently, narcolepsy medications work well for many with my diagnosis, but not for me (narcolepsy is similar to hypersomnia, with one main difference being that narcoleptics go into REM sleep almost immediately) But she has been insistent on me keeping consistent sleep hygiene, i.e., going to bed and getting up at the same time every day, no matter how I sleep during the night. That’s often easier said than done. I often get to the point, sometimes even by mid-morning, when I simply cannot keep my eyes open. And I’m still very difficult to awaken. And now, I often have nights when I simply cannot fall asleep, either, even if I’m exhausted.
    I haven’t worked for the last few years, and some of my doctors are now suggesting I can’t go back to work without medication that works for me. That’s frustrating. And I often don’t have the energy to do much, even if I can stay awake. I’m learning to cope with this, slowly. But I wonder if they’ll ever discover something through research that can give me my quality of life again.
    I have read that sleep issues can set off episodes of mania in people with bipolar I. Sleeping longer than 9 hours on a regular basis can be a sign of a depressive episode in bipolar II. I definitely feel “off” the day after I’ve had a mostly-sleepless night, and have wondered if that is what the sleep disorder is doing to aggravate my bipolar. I don’t think there are any clear answers in this area, though. I just hope they continue doing research.
    Mainly, I wanted to tell you that you’re not alone, and that it is possible to have both bipolar and a sleep disorder. In fact, I understand that sleep problems are very common with mood disorders. You just need to find specialists for each illness who will communicate with each other. I’ve been trying to get my sleep doctor to start a support group for others with this diagnosis, too. I’ve met a couple of people who also have hypersomnia, but medication works for them, so they don’t have the same problems that I do. I think it helps to talk to people who are going through the same difficulties.
    Thanks for sharing! 🙂

  • 11. Claire  |  February 11, 2011 at 3:57 pm

    I have been diagnosed with bipolar. I took medication for six years. My bipolar doctor had me see my regular family doctor for a sleep study, which I had done at the hospital by a specialist. I have been on auto pap machine ever since. I no longer need bipoalar medication. I worked with my doctor to go off it. I have had my auto pap for ten months. I strap it on really tight. I also had my broken nose fixed. I finally feel great!! Good Luck Everyone with feeling better.

  • 12. Claire  |  February 11, 2011 at 5:46 pm

    I should also add, the auto pap, unlike the c pap, forces air into the lungs. This, hence, gives the brain more oxygen.
    The fixing of the broken nose adds in also delivering oxygen to the brain. These efforts combined with medication for,as long as you need it, could be what it takes to get better; as was the case for me.

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Hi, I'm James. I'm a 26 year old guy from England with bipolar disorder (currently well controlled). I also have a circadian rhythm sleep disorder (not so well controlled). This blog has charted my journey from mental illness, through diagnosis and, recently, into recovery. It's not always easy, but then, what is?

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