Sleep Disturbances and Bipolar Disorder

One thing my psychiatric mental health nurse practitioner (PMHNP) said at my intake appointment a few days ago is that sleep is one of the most difficult things to treat in individuals with bipolar disorder. I can certainly relate, as I have had issues with sleep for years now. Sleep disturbance can present itself in a number of ways. I will only discuss insomnia and excessive somnolence here. Insomnia, which can be acute or chronic, is a sleep disorder that makes it difficult to fall and/or stay asleep. For the purposes of this post, somnolence, which can be caused by insomnia, is daytime sleepiness.

Probably beginning in high school and continuing through college, I would stay awake during the late night hours or take super short naps throughout the night in order to complete assignments that I just couldn’t seem to get done during the typical waking hours. Perhaps this was an early indicator of my bipolar diagnosis. Based on my very limited Google Scholar search, it is unclear whether sleep deprivation triggers bipolar mania or vice versa. While causation is unclear, the literature does seem to lean towards the former. It also agrees that improving one’s sleep may prevent relapse.

I have grown accustomed to not being able to stay asleep during the night and to feeling sleepy throughout the day. However, I did express to my PMHNP that I would at least like to try to improve my quality of sleep. Because I do not get adequate sleep and my body finds it impossible to sleep in, I nap throughout the day if I’m not working. I feel like this really hinders my productivity, and, in some ways, worsens my quality of life.

I wonder whether the psychiatric medications I am on may also contribute to my excessive somnolence. At least two out of the three psych meds I’m on have side effects of drowsiness, tiredness, and even insomnia. It is difficult to determine whether my medication aggravates my sleep difficulties or if I would have these issues anyway. One thing I do know is that I experience sleep disturbances even when I am euthymic. This is one indication that I am actually not experiencing prodromal symptoms of mania; I wouldn’t feel the need for sleep if I were. Instead, I would have the energy to do everything and more despite a lack of sleep. This is not the present case.

I think that iron deficiency is another contributor to my excessive somnolence. My iron levels have been lower than low in the past. So low in fact that I had to be prescribed iron pills. Knowing what I know now about sleep and bipolar disorder, in conjunction with the fact that I have a lot of significant life changes occurring, I think it is wise to finally get a handle on my sleep problem.

In the past I have tried melatonin and trazodone but neither helped. My current PMHNP wants me to try Ambien. Since I don’t have work tomorrow, I intend to take the medication tonight when I get home from work. My sleep disorder and feeling like I need sleep all the time is actually normal for me, and that’s not okay. I am hopeful that whatever the cause of my insomnia and excessive somnolence, this newly-prescribed drug will help me feel rested. I am ready to function at my optimal level instead of struggling to get through each day.

Signed,

Bipolar I