the need for sleep
Since I’ve always had a sensitive biological clock, I’ve always been intrigued by research around sleep. One of the first questions they ask you when you have a depressive disorder (either unipolar depression or bipolar) is “How’s your sleep been lately?” They know that sleep is the key – although, as with so many other things in the psychiatric/mental health professions, they don’t know how or why. It’s one of the old chicken/or/egg dilemmas… and, as the Chief of the Bipolar Disorders clinic at UCSF once told me, if you look at doctors doing their residency and becoming sleep deprived, the longer you go without sleep the harder it is to sleep. In other words, “everyone is a little bit bipolar”.
The question is, why does it spiral out of control in some people and not in others? One emerging theory is that people with bipolar disorder just have really sensitive “biological clocks” (circadian rhythms) and even flying from the West to the East Coast can spark mania in some bipolars.
This link explores the sleep gene and has found that although most fruit flies sleep 12 hours a day, a few have some mutation that effects their potassium ion channel which doesn’t allow their brain to rest, and only sleep two hours a night or so. The article mainly discusses the effects of sleeplessness, which we all know, if we’ve gone to college, what pulling an all-nighter or two will do.
Studies show that sleep disturbance is not just a symptom of mania, but often precipitates mania… a 25-65% of people who go on to experience a manic episode began with a disturbance in their routine.
New therapies are being developed, such as making sure the person maintains a schedule, sleeps 8 hours a night, always with the same bedtime and always with the same wake time. “Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may be of particular help for treatment-resistant rapid cycling bipolar disorder. Such therapy may begin by enforcing complete light and sound deprivation for as many as 14 hours per night, which can be gradually reduced once the patient’s moods are seen to stabilize.” – from About.com’s bipolar link
Also, room darkening curtains should be considered, which lower the incidence of artificial light creeping into a bedroom at night (I know at least mine, since I live right off of a street permanently lit with streetlamps). Artificial light interferes with the brain’s seratonin mechanisms which are indicated in depressive disorders. Artifical light has also been indicated as a reason why depressive disorders are on the rise.
Can lack of sleep drive you crazy? This article says that lack of sleep actually looks to CAUSE psychological disorders. From the article: “The researchers mainly monitored the amygdala, a midbrain structure that decodes emotion, and observed that both sets of volunteers had a similar baseline of activity when shown the innocuous images. But, when the scenes became more gruesome, the amygdalae of the sleep-deprived participants kicked up, showing 60 percent more activity relative to the normal population’s response. In addition, the researchers noticed that more than five times more neurons in the area were transmitting impulses in the sleep-deprived brains.”
Now I wish I could find a comparison brain scan between a bipolar brain and a sleep deprived brain, but I haven’t found any good shots. My guess is they’d look very similar.