Essentials of Sleep

By Sandra Kiume
December 11, 2007

Here’s more info after John wrote about bipolar disorders and sleep patterns with Interpersonal and Social Rhythm Therapy (IPSRT), a treatment developed by Ellen Frank and colleagues combining psychotherapy with lifestyle management. Regulating bedtimes, routines and practicing good sleep hygiene (like no caffeine at night, use your bed only for sleep, exercise in the afternoon) prevent “relapse” into new episodes of mania or depression. Mania and hypomania are both accompanied and triggered by decreased sleep while bipolar depression usually features hypersomnia (sleeping very long hours).

Scientists have been researching the relationship between sleep cycles, a.k.a. circadian rhythms, and bipolar disorder for decades but recent research breakthroughs have more clearly shown that it seems the right track to pursue. Colleen McClung’s genetic experiments with mice who became manic without the CLOCK gene is one good example. But even before her promising research, there were signposts.

Lithium and valproate (Depakote, Epival) are considered the gold standard mood stabilizers for bipolar disorders. These two drugs are the only medications that regulate certain clock gene expression, which may be one reason more effective drugs for bipolar have not emerged yet. There’s a really terrific overview of lithium and bipolar, written for the general public, by chronobiologist ScienceBlogger Bora Zivkovic. Lithium, Circadian Clocks and Bipolar Disorder incorporates several pieces he wrote on the topic, especially Bipolar? Avoid Night Shifts about the work of Cindy Ehlers, Ellen Frank et al. on disruptions caused by shift work. Ehlers coined the word “zeitstorer” which means something that throws off a daily routine. I can imagine it catching on: “No thanks, I don’t want to go to that late movie, it’s a zeitstorer. Let’s see the matinee.”

We now also know that working night shifts and swing shifts are a probable cause of cancer and increase risk for diabetes. All in all, it’s clear that it’s essential to get regular, adequate sleep, especially if you have a bipolar disorder.

Ellen Frank’s book Treating Bipolar Disorders: A Clinician’s Guide to Interpersonal and Social Rhythm Therapy was published in 2005 and research articles on the subject have been published for nearly a decade. Yet this simple treatment method has not yet reached street level with most psychiatrists and psychotherapists and it’s difficult to find someone trained in the technique. Fortunately, social rhythms including regular sleep are something people can manage with self-help. And then there’s the role of light on sleep cycles… check out the comments here.

A great half-hour video was produced by UCSD-TV’s Health Matters: Sleep Disorders. Among other things, learn about the effects of sleep deprivation you may not even notice and that a recommended eight-hour sleep period is a myth created by industrialization and many people need ten hours for their brains to have good cognitive function (memory, etc.). Next time someone says you’re lazy for sleeping in, tell him or her that you’re preventing cancer and practicing bipolar relapse prevention skills.

Sandra Kiume is a mental health advocate and editor of Channel N who lives in Vancouver, Canada.