Does this sound familiar?
Yesterday morning it took an hour-and-a-half attempting to get him up. We kept shaking him, beseeching, threatening, beseeching anxiously…. We even called his cell phone thinking he might pick it up for a friend’s call. He simply growled, muttered something we would have preferred not to hear, and turned over and went back to sleep.
We finally did see him rise from the bed and we ran the shower thinking that might wake him up. Ten minutes later we found him in the bathroom curled up on the bath mat, sound asleep.
A father detailed his family’s three-stage morning routine with their six-year-old daughter:
I carry her downstairs to the living room sofa. I leave the room and my wife pulls off her pajamas and dresses her while she’s still asleep (that’s stage one). Stage two: We help her into the kitchen, although she’s still very groggy, sit her in a chair, and give her an “injection of breakfast” by shooting a GoGurt (yogurt in a squeezable tube) in her mouth. Stage 3: We carry her to the bathroom and help her brush her teeth, etc. Then we put on her coat and go outside and wait for the bus (or shall we say, the bus waits for us). Sometimes.
Every morning, in America and abroad, many parents of bipolar children wake up and experience dread as they prepare to get their children up for school. Contrary to cheery television commercials where families gather around quaffing fresh-squeezed orange juice, these parents often forgo that fantasy and mount a siege simply to get their children out of bed.
It’s a tall order. While it may seem as if the child or adolescent is behaving in an oppositional manner, a great many of these youngsters actually suffer from something called sleep inertia.
What Is Sleep Inertia?
Sleep inertia is a transitional state of lowered arousal occurring immediately after awakening from sleep and producing a temporary decrement in any subsequent performance. Studies show that sleep inertia can last from a few minutes to four hours. Youngsters with bipolar disorder are far closer to the latter than the former. One 17-year-old girl described her attempts to get up in the morning this way:
I feel as though my insides are whining. I will do anything not to get up. Sleep is more important than anything in the world. I could sleep until 4:00 in the afternoon.
I never think about it from my mother’s point-of-view. I don’t think anything. When I do get to school (after much yelling by my mother and me back at her), I have my head on the desk until somewhere around 11:00 in the morning. Right before lunch I seem to truly get up.
Several factors are involved in sleep inertia. A child may be depressed and chronically tired, or the thought of facing the school day may produce waves of anxiety or panic, forcing the child to choose sleep or somatic complaints over the trial of going into the school environment. In many cases, the medications may be causing an early-morning sleepiness.
We do know that children with bipolar disorder have disturbances in the architecture of their sleep—they have sleep/wake reversals and are activated at night and slowed-down in the morning. There is considerable evidence in the adult literature to suggest that several elements of the sleep/wake cycle are altered in people suffering with mood disorders.