September 2013, 15:402
Date: 17 Sep 2013
Recent Advances in Sleep-Wake Cycle and Biological Rhythms in Bipolar Disorder
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The cyclical nature of periodic switches in energy, motor activation and sleep-wake cycles in bipolar disorder suggests a strong underlying relationship with disturbances in chronobiology. Current research is refining our understanding of the various patterns of sleep-wake and biological rhythms alterations at early and later stages of this illness, as well as across its depressive/fatigue, manic/hypomanic and euthymic phases. This research focuses on early detection and subsequent monitoring to predict and better manage recurrent episodes. Sleep-wake cycle and biological rhythms disturbances are also well known to affect other key aspects of physical health (notably metabolic functions), cognitive performance and elevated risks for suicide. Increasing evidence now supports the integration of behavioural or pharmacological therapeutic strategies that target the sleep-wake and circadian systems in the ongoing treatment of various phases of bipolar disorder.
This article is part of the Topical Collection on Sleep Disorders
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
•• Hickie IB, Rogers NL. Novel melatonin-based therapies: potential advances in the treatment of major depression. Lancet. 2011;378(9791):621–31. Recent review commenting the emergence of new generations of agents acting on the melatoninergic system and their applications to mood disorders.PubMedCrossRef
Wirz-Justice A. Chronobiology and mood disorders. Dialogues Clin Neurosci. 2003;5(4):315–25.PubMed
Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473–81.PubMed
•• Glozier N et al. Short sleep duration in prevalent and persistent psychological distress in young adults: the DRIVE study. Sleep. 2010;33(9):1139–45. Prospective study conducted in a large community sample indicating that sleep duration is associated with persistent psychological distress.PubMed
• Fukuyama H, Uchimura N. Changes in rectal temperature rhythm on manic states of bipolar patients. 久留米大学文学部紀要, 社会福祉学科編. 2011;10:53–8. One of the rare studies providing information about endogenous circadian rhythms during mania episodes.
Brill S et al. Sleep disturbances in euthymic bipolar patients. Ann Clin Psychiatry. 2011;23(2):113–6.PubMed
•• Murray G et al. Do symptoms of bipolar disorder exhibit seasonal variation? A multisite prospective investigation. Bipolar Disord. 2011;13(7–8):687–95. Multisite study providing prospective data on depression and mania symptoms assessed by clinician rating scales over at least a year in a large sample of persons with BPAD.PubMedCrossRef
Akhter A, et al. Seasonal variation of manic and depressive symptoms in bipolar disorder. Bipolar Disord. 2013;15(4):377–84.
•• Yang AC et al. Effects of age, sex, index admission, and predominant polarity on the seasonality of acute admissions for bipolar disorder: a population-based study. Chronobiol Int. 2013;30(4):478–85. Investigates demographic and clinical correlates of seasonality in over 9600 people with BPAD.PubMedCrossRef
•• McCarthy MJ et al. A survey of genomic studies supports association of circadian clock genes with bipolar disorder spectrum illnesses and lithium response. PLoS One. 2012;7(2):e32091. Genome-wide association study focussing on multiple levels of the clock gene network inBPAD based on a vast shared genetic database.PubMedCrossRef
Wehr TA, Sack DA, Rosenthal NE. Sleep reduction as a final common pathway in the genesis of mania. Am J Psychiatry. 1987;144(2):201–4.PubMed
• Ritter PS et al. The characteristics of sleep in patients with manifest bipolar disorder, subjects at high risk of developing the disease and healthy controls. J Neural Transm. 2012;119(10):1173–84. Reports similarities in objective and subjective sleep and circadian measures in persons at risk for BPAD and those with established disorder. One of the rare studies to report data on subjective sensitivity to circadian shifts.PubMedCrossRef
• Eidelman P et al. Sleep, illness course, and concurrent symptoms in inter-episode bipolar disorder. J Behav Ther Exp Psychiatry. 2010;41(2):145–9. Investigates associations between current sleep-wake patterns as measured by sleep diaries and retrospective reports of BPAD course and symptoms during clinical interviews. Highlights the clinical relevance of sleep disturbances occurring in between BPAD episodes.PubMedCrossRef
Haack M, Sanchez E, Mullington JM. Elevated inflammatory markers in response to prolonged sleep restriction are associated with increased pain experience in healthy volunteers. Sleep. 2007;30(9):1145–52.PubMed
Liang FQ, Allen G, Earnest D. Role of brain-derived neurotrophic factor in the circadian regulation of the suprachiasmatic pacemaker by light. J Neurosci. 2000;20(8):2978–87.PubMed
• Robillard R, et al. Sleep-wake cycle in young and older persons with a lifetime history of mood disorders. Submitted 2013. Provides evidence that the sleep-wake profiles linked to mood disorders vary across different age groups. Proposes that sleep and circadian-based interventions for mood disorders should be adapted to specific age groups.
•• Robillard R et al. Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders: Comparison of unipolar and bipolar phenotypes. European Psychiatry. 2013. doi:10.1016/j.eurpsy.2013.04.001. Indicates that in young persons with mood disorders, delayed and reduced evening melatonin secretion are more pronounced in those with the bipolar subtype that in those with unipolar depression.PubMed
• Mullin BC, Harvey AG, Hinshaw SP. A preliminary study of sleep in adolescents with bipolar disorder, ADHD, and non-patient controls. Bipolar Disord. 2011;13(4):425–32. Suggests a discrepancy between objective and subjective sleep-wake cycle measures in young persons with BPAD, potentially highlighting sleep misperception and/or subtle undetected sleep abnormalities in this population.PubMedCrossRef
• Roybal DJ et al. Characterization and factors associated with sleep quality in adolescents with bipolar I disorder. Child Psychiatry Hum Dev. 2011;42(6):724–40. Describes the sleep profile associated with BPAD during adolescence and highlights an association between sleep disturbances and excessive guilt, self-injurious behavior, and worsening evening mood in young BPAD patients.PubMedCrossRef
• Scott E, et al. Sleep-wake patterns are dysregulated during early stages of major mental disorders. Submitted 2013. Highlights sleep-wake cycle differences across stages of illness in young persons with neuropsychiatric disorders.
• Walz JC, et al. Daytime sleepiness, sleep disturbance and functioning impairment in bipolar disorder. Acta Neuropsychiatrica. 2013;25(2):101–4. Suggests that both sleep disturbances and sleepiness independently add to the disability of BPAD.
• Angelis G et al. Comparative study between the perception of quality of sleep and quality of life, depressive and anxiety symptoms in euthymic bipolar disorder. Neurobiologica. 2010;73(3):31–44. Highlights an association between subjective sleep and quality of life in BPAD.
•• McKenna BS, Eyler LT. Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies. Clin Psychol Rev. 2012;32(7):650–63. Draws an interesting parallel between the impacts of sleep loss on cognitive and emotional functioning which is well documented in healthy persons and the possible role of sleep disturbances on cognitive and affective dysfunctions linked to BPAD.PubMedCrossRef
•• Boland EM, Alloy LB. Sleep disturbance and cognitive deficits in bipolar disorder: toward an integrated examination of disorder maintenance and functional impairment. Clin Psychol Rev. 2013;33(1):33–44. Another recent review supporting the role of sleep disturbances in cognitive dysfunctions associated with BPAD.PubMedCrossRef
•• Naismith SL et al. Sleep disturbance relates to neuropsychological functioning in late-life depression. J Affect Disord. 2011;132(1–2):139–45. Provides empirical evidence based on objective data supporting the association between sleep-wake cycle disturbance and cognitive functioning in the context of mood disorders.PubMedCrossRef
• Rajajarvi E et al. The effect of seasons and seasonal variation on neuropsychological test performance in patients with bipolar I disorder and their first-degree relatives. J Affect Disord. 2010;127(1–3):58–65. Empirical study suggesting that cognitive dysfunctions in BPAD are also influenced by infradian rhythms.PubMedCrossRef
Anderson G. Melatonin and cognitive deficits in bipolar disorder and mild cognitive impairment. Psychother Psychosom. 2012;81(4):244.PubMed
Migliorini M, Mendez MO, Bianchi AM. Study of heart rate variability in bipolar disorder: linear and non-linear parameters during sleep. Front Neuroeng. 2011;4:22.PubMed
•• Aydin A, et al. Mood and metabolic consequences of sleep deprivation as a potential endophenotype’ in bipolar disorder. J Affect Disord. 2013;150(2):284–94. Demonstrates experimentally that sleep loss induces distinct endocrine and affective reactions in persons at risk for BPAD compared to controls.
Gunnell D, et al. Sleep and suicide: an analysis of a cohort of 394,000 Taiwanese adults. Soc Psychiatry Psychiatr Epidemiol. 2013;48:1457–65.
McCall WV et al. Nightmares and dysfunctional beliefs about sleep mediate the effect of insomnia symptoms on suicidal ideation. J Clin Sleep Med. 2013;9(2):135–40.PubMed
Nadorff MR, Nazem S, Fiske A. Insomnia symptoms, nightmares, and suicidal ideation in a college student sample. Sleep. 2011;34(1):93–8.PubMed
Bjorngaard JH et al. Sleeping problems and suicide in 75,000 Norwegian adults: a 20 year follow-up of the HUNT I study. Sleep. 2011;34(9):1155–9.PubMed
• LeGates TA et al. Aberrant light directly impairs mood and learning through melanopsin-expressing neurons. Nature. 2012;491(7425):594–8. Animal study demonstrating that chaotic light exposure modulate mood. Creates an attractive model for studying the potential role of alterations in the most important synchroniser of the biological clock in the emergence of mood disorders.PubMedCrossRef
Robillard R, et al. Habitual physical activity is associated with better sleep. Submitted 2013.
Rimer J et al. Exercise for depression. Cochrane Database Syst Rev. 2012;7, CD004366.PubMed
NICE, N.I.f.H.a.C.E. Bipolar disorder clinical guideline. 2006: London.
•• Benedetti F. Antidepressant chronotherapeutics for bipolar depression. Dialogues Clin Neurosci. 2012;14(4):401–11. Recent review covering the application of some sleep and circadian-based interventions in BPAD.PubMed
•• McElroy SL et al. A randomized, placebo-controlled study of adjunctive ramelteon in ambulatory bipolar I disorder with manic symptoms and sleep disturbance. Int Clin Psychopharmacol. 2011;26(1):48–53. One of the first double-blind trials showing the efficacy of melatoninergic agents for depressive symptoms in BPAD.PubMedCrossRef
• Norris ER et al. A double-blind, randomized, placebo-controlled trial of adjunctive ramelteon for the treatment of insomnia and mood stability in patients with euthymic bipolar disorder. J Affect Disord. 2013;144(1–2):141–7. Suggests that melatoninergic agents can contribute to reduce relapse in persons in the euthymic phase of BPAD.PubMedCrossRef
Hoberg AA, et al. Group interpersonal and social rhythm therapy for bipolar depression. Perspect Psychiatr Care 2013. In Press.
•• Bouwkamp CG et al. Interpersonal and social rhythm group therapy for patients with bipolar disorder. Int J Group Psychother. 2013;63(1):97–115. Longitudinal study showing that interpersonal and social rhythm group therapy reduces depressive symptoms in BPAD, leading to remission rates of nearly 65% 1 year after the end of treatment.PubMedCrossRef
- Recent Advances in Sleep-Wake Cycle and Biological Rhythms in Bipolar Disorder
Current Psychiatry Reports
- Online Date
- September 2013
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Bipolar disorder
- Biological rhythms
- Sleep disorders
- Industry Sectors