Why You Need Good Sleep — and How to Get It — if You Have Bipolar Disorder

woman resting half asleep in bright bedroom holding phone set to exact wake up and sleep alarms to get better sleep with bipolar disorder.Konstantin Aksenov/iStockNobody functions at their best without enough shut-eye, but for people with bipolar disorder (formerly known as manic depression), sleep problems can indicate trouble.

In fact, the relationship between bipolar disorder and sleep issues is a two-way street. Poor sleep can worsen symptoms of bipolar disorder, and bipolar symptoms can interfere with your ability to sleep, says Jennifer Martin, PhD, a spokesperson for the American Academy of Sleep Medicine (AASM) and a professor at the Herbert Wertheim College of Medicine at Florida International University in Miami.

Scientists haven't yet pinpointed the connection between poor sleep and bipolar disorder. Sleep disorders are almost universal during major mood episodes for people with bipolar. But even between episodes, people with the condition have poorer sleep than people without it, according to research.

Here, find out what this means for you, and what you can do about it to improve your sleep.

It's vital to be mindful and protective of your sleep cycle if you've been diagnosed with bipolar disorder. This is true even if you're feeling stable and are functioning well, without symptoms, because sleep problems are common in people with bipolar disorder and can trigger new bipolar episodes, according to research.

And one study found that insomnia and sleepiness are particularly prevalent in people with bipolar disorder, even when not experiencing a mood episode. It also showed that treating insomnia or sleepiness during different mood states could improve quality of life.

"Even if someone makes do on little sleep, it can have repercussions, such as increased moodiness, depression, worry, difficulty concentrating, and even a higher risk for accidental death in a worst-case scenario," says Sanam Hafeez, PsyD, a psychologist in New York City, and the director of Comprehensive Consultation Psychological Services, a center for neuropsychological, psychiatric, and educational difficulties.

If you're having sleep issues, tell your doctor as soon as possible, says Gonzalo Laje, MD, the CEO of Washington Behavioral Medicine Associates in Chevy Chase, Maryland.

The sleep issues that people with bipolar disorder experience can vary. For example, some may find they need less sleep, while others may feel they can't get enough sleep.

If you are experiencing the highs of bipolar disorder (hypomania or mania), you may suddenly need dramatically fewer hours of sleep to stay alert and energized. For example, if you regularly sleep eight hours, you may feel you're rested on as little as four hours of sleep.

This is because mania can be so exciting or stimulating that you don't feel tired, even when you're running on much less sleep than normal, Dr. Hafeez says.

"Difficulties falling asleep, on the other hand, are events more likely to happen when patients are undergoing a depressive episode, [which are the lows of bipolar disorder]," says Dr. Laje. "For example, some patients try to sleep but can't fall asleep, or they have disrupted sleep, such as waking up in the middle of the night and not being able to go back to sleep or waking up too early."

The following sleep problems are common among people with bipolar disorder, according to research.

Insomnia is difficulty falling asleep, difficulty staying asleep throughout the night, waking up too early in the morning, or a combination of these.

Hypersomnolence can cause excessive daytime sleepiness, an increase in overall sleep time, and sleep inertia, or sleepiness even after waking.

Obstructive sleep apnea causes a person's breathing to become shallow or very briefly stop altogether while asleep, disrupting sleep and often leading to excessive daytime sleepiness.

Sleep talking and sleepwalking are both types of parasomnia, or abnormal behavior during sleep. Sleep talking is harmless, but sleepwalking can sometimes lead to injury.

Nightmares, excessive dreams, and hallucinations are also types of parasomnias that can disrupt sleep and are common among people with bipolar disorder.

Delayed sleep-wake phase disorder causes people to fall asleep and wake up much later than intended.

In the same way that bipolar disorder can cause sleep issues, the reverse can also be true: Lack of sleep can exacerbate bipolar symptoms. For many with bipolar disorder, sleep issues are actually the most common cue that a manic episode is looming, says Hafeez.

A research review found that alterations to sleep patterns seem to predict mood episodes. Manic and hypomanic episodes were preceded by shorter sleep duration, while depressive episodes were preceded by worse sleep efficiency, which is the percentage of time you spend asleep while you're in bed. The higher the percentage, the greater your sleep efficiency.

The study authors noted that shift work is one situation that could predispose someone to high mood episodes. Hafeez adds two others: "Jet lag, as well as sleep deprivation, can trigger hypomanic or manic periods for some with this disorder."

As noted, research has shown a link between bipolar disorder and sleep, such as the fact that bipolar disorder can have a significant impact on how much and how well you sleep, and lack of sleep can increase your risk of manic or depressive episodes. Given that, it's clear that addressing sleep issues is an important part of managing bipolar disorder.

Here are some strategies from experts on how to get the sleep you need.

As with all mood disorders, treatment by a mental health professional can improve your symptoms, including sleep issues, says Dr. Martin.

Also consider scheduling an appointment with a doctor at an accredited sleep disorders center near you. "There are many board-certified sleep medicine physicians who are neurologists and psychiatrists, who may be especially well suited to help," she says. Organizations such as the AASM have search tools to help you find a sleep center near you.

"In addition, if people with bipolar disorder struggle with insomnia even when their mood symptoms are stable, they can still benefit from direct treatment of insomnia by a behavioral sleep medicine specialist like a clinical sleep psychologist," says Martin. Cognitive behavioral therapy, which focuses on replacing unhelpful thinking and behavior patterns with healthier ones, is commonly used to treat insomnia and can be safely adapted for people with bipolar disorder, she says. There is even a form of cognitive behavioral therapy specifically designed to treat insomnia, often referred to as CBT-I.

Medications used to treat bipolar disorder may cause sleep issues as a side effect, Martin says. They may also interact with other medications or supplements you're using and cause sleep problems.

Ask your doctor if you should take your medications at specific times of day to minimize their impact on your sleep. For instance, Martin says, if a medication makes you feel drowsy, ask if you can take it at night rather than during the day.

Sometimes, adjustments to the types or doses of medication can help. But always talk to your doctor before making any changes to your medication regimen, to avoid worsening your bipolar symptoms.

Going to bed at the same time each night and waking up at the same time each morning as consistently as possible will help you maintain your circadian rhythm, the internal clock that regulates your sleep-wake cycle. This, in turn, will improve your shot at a good night's rest and reduce your risk of mood episodes down the road, says Martin.

"People with bipolar disorder should be particularly careful to avoid periods of sleep deprivation, as this is one factor that can contribute to mania," she says.

Keep track of your sleep habits and symptoms over time, so you and your doctor can detect patterns that may be preventing you from getting a good night's sleep. Hafeez suggests using a sleep diary each morning to jot down:

How long it took you to fall asleep the previous night

How many times you woke up during the night

Any medications you took to help you sleep

Whether you had caffeine or alcohol prior to bedtime

Whether you exercised during the day, including what time you exercised and for how long

Use the last hour or two before bed to prepare your body for sleep. This means avoiding bright lights, cell phones, and stimulating activities, says Hafeez. And before you turn in for the night, "Place your cell phone facedown, so the light is not emitted from it," she says.

And although regular exercise is helpful for managing bipolar symptoms, exercising too close to bedtime can be stimulating and make it difficult to fall asleep, she says. To avoid this, exercise earlier in the day.

To prepare your body for bedtime, Hafeez suggests that you:

Avoid caffeine and alcohol late in the day.

Keep your bedroom as quiet and dark as possible.

Maintain a room temperature that's not too cold or hot. A bedroom temperature of 60 to 67 degrees F can deepen sleep.

Use blackout shades, earplugs, and a sleep mask to block excessive light and noise.

Play calming background music as you drift off.

Nicotine is a stimulant, so if you smoke or vape, avoid doing so in the two hours before you sleep.

Bright light therapy is often used to manage circadian rhythm disorders like delayed sleep phase syndrome and can gradually normalize your sleep patterns.

Studies on bright light therapy in bipolar disorder have led to conflicting results, according to a research review. One study found that sleep quality improved significantly in people with bipolar disorder who tried bright light therapy, while the participants in another study did not see much improvement in sleep, compared with a control group who didn't receive the treatment. The review's authors suggested that people doing bright light therapy might see a larger improvement in sleep by also reducing their light exposure at night, however.

To get the most out of bright light therapy, it's recommended that you use the device as soon as possible after you wake up in the morning. There are many bright light therapy devices available to purchase. Ask your doctor to recommend the best one for you.

Bipolar disorder affects sleep, and vice versa, so it's important to get the best sleep you can.

While the connection is not yet fully understood, it's known that sleep disruptions can occur in any mood state.

Poor sleep can even trigger mood episodes, so let your doctor know if you're having trouble getting the sleep you need; there are a number of treatments that can help.

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

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