Expert: Ivan Goldberg, M.D. - 4/25/2011

Question
Hi there,
I am currently studying psychology, I am a second year student and I was intrigued into the relationship between sleep and bipolar as it was brought up in a couple of my papers. Is it possible for a patient to be manic or hypomanic if all other symptoms are present except for sleep abnormalities other than sleep deprivation by choice? Or in other words, can an individual be considered manic/hypomanic if they have no problems with sleeping, but they do have decreased sleep, and it is only due to lack of sleep by deliberate choice i.e through persuit of pleasurable activities.(staying up all night partying etc.)

How is the "decreased need for sleep" measured?
Because interestingly, although there is a clear relationship between how much sleep and onset of manic/hypomanic episodes, it isn't necessarily the bipolar that is CAUSING the lack of sleep- in fact some of the journals say that that it is "psychosocial stresses are proposed to cause disrupted routine and sleep, which in turn... triggers an episode" (Sorry about the lack of references)

Furthermore, (as a sidenote) if this were the case, then couldn't the individual also be diagnosed with BPD if other criterion were present? This area seems awfully murky to me, if you could clarify the relationship between sleep with mania/hypomania that would be awesome :) From your own experience with patients, or from any sources either or would be great!


Kind regards and much appreciated,

Katherine

Answer
Hi Katherine . . .

The relationship between sleep and bipolarity is a circular one. Lack of sleep can cause hypomania/mania, and hypomania/mania can reduce the need for sleep. Reduced need for sleep is simply the patient relating that they are sleeping fewer hours than usual and not feeling tired or experiencing any reduced effectiveness as a result.

While decreased need for sleep is one of many possible criteria for the diagnosis of a hypomanic/manic episode, it is not required to make the diagnosis. To make the diagnosis you need three (or more) of the following:

•Inflated self-esteem or grandiosity
•Decreased need for sleep
•More talkative than usual or pressure to keep talking
•Flight of ideas or subjective experience that thoughts are racing
•Distractibility
•Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
•Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Best regards . . .

Ivan
%%%%%%%%%%%%%%%%%%%%%%