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Bipolar disorder disrupts sleep patterns, and sleep challenges worsen bipolar symptoms. Prioritizing better rest can help stabilize mood.
Sound sleep in our busy society can be an elusive dream with profound implications for the way we live.
“We are living in the middle of history’s greatest experiment in sleep deprivation and we are all part of that experiment,” says Robert Stickgold, PhD, a sleep research specialist and associate professor of psychiatry at Harvard Medical School. While Dr. Stickgold made this dramatic assertion in a 2005 Harvard Magazine article, have things changed much?
Startling statistics gathered over the past decade show that Americans are sleeping less than ever — and it’s impacting both physical and mental health.
Americans today sleep far less than people did 100 or even 50 years ago. Moreover, data published by the Centers for Disease Control and Prevention (CDC) in 2022 found one-quarter of U.S. adults sleep less than the recommended seven hours per night.
Indeed, says Stickgold, “it’s not inconceivable … that we will discover that there are major social, economic, and health consequences to that experiment. Sleep deprivation doesn’t have any good side effects.”
Data gathered by Statista Consumer Insights in 2023 found that 39 percent of American adults experienced a sleep disorder, such as insomnia, over the past 12 months. What’s more, about 10 percent of the population has chronic insomnia, according to Cleveland Clinic.
And people are feeling the impact of not getting enough sleep: A 2020 poll from The National Sleep Foundation found that half of Americans report feeling sleepy between three and seven days a week.
Impacts of Poor Sleep With Bipolar Disorder
As difficult as getting a good night’s sleep is for most people, those who live with bipolar disorder know all too well the significant health costs of poor sleep.
“Most people who don’t have bipolar disorder have a consistent sleep problem over a long period of time. In people who have bipolar disorder, sleep problems often occur cyclically,” explains Michael J. Thorpy, MD, director of the Sleep-Wake Disorder Center at Montefiore Medical Center in Bronx, New York.
“They may fluctuate week to week or month to month. So in the manic or hypomanic phases, they get very little sleep but at times of depression, they may sleep or just stay in bed for excessive amounts of time,” explains Dr. Thorpy.
Medication Side Effects and Sleep: Finding the Right Balance
Medications used to treat bipolar also sometimes disrupt sleep. Many widely prescribed mood stabilizers may cause fatigue and sedation, while several popular antidepressants often lead to agitation and insomnia.
Fortunately, these side effects can often be managed. Adjusting the dosage may help reduce or even eliminate them. Timing also plays a role — if a medication causes sleeplessness, taking it in the morning might be a better option. Finding the right balance requires a psychiatrist who is patient and willing to fine-tune medications to support both mood stability and quality sleep.
While sleep challenges are common for those with bipolar disorder, good choices and habits can make a significant difference. “Behavioral changes to support good sleep are absolutely essential,” emphasizes Thorpy. “The more individuals can maintain a regular sleep-wake pattern, the better they will feel.”
The Power of Sleep: Why It Matters for Mental Health
“The process of sleep, if given adequate time and the proper environment, provides tremendous power,” says James B. Maas, PhD, professor of psychology at Cornell University and author of Power Sleep: The Revolutionary Program That Prepares Your Mind for Peak Performance.
“It restores, rejuvenates, and energizes the body and the brain. The one-third of your life that you spend sleeping has profound effects on the other two-thirds,” he explains. Quality sleep influences everything from alertness, mood, and memory to body weight, reaction time, productivity, and overall health.
RELATED: Sleeping Too Much With Bipolar? Here’s Why It Happens and What Helps
Dr. Maas acknowledges the complex relationship between sleep and bipolar disorder: “Depression can cause extensive insomnia, and insomnia can cause depression — which comes first depends on the individual and the circumstance.” Mania, too, frequently leads to insomnia, further complicating sleep patterns.
With 75 percent of the population already sleep-deprived during the week, any additional stress — whether personal, professional, or related to a mood disorder — can make sleep struggles even worse. However, Maas emphasizes that improving sleep, even within the challenges of bipolar disorder, can make a meaningful difference: “The better your sleep habits, the more alert and energized you’ll be.”
From Sleepless Nights to Awareness: Bill’s Journey
“I used to joke that I didn’t go to bed at night and get up in the morning—I passed out and came to,” says Bill, a volunteer with the Depression and Bipolar Support Alliance (DBSA) in Oklahoma City.
For years, sleep was an afterthought. As the owner of seven companies in advertising and PR, Bill thrived on high energy. He even started a nightlife newspaper, The Entertainer, since he was already awake at all hours. “I’d party, close the clubs, then go out for breakfast with the musicians,” he recalls. Running on just three to four hours of sleep, he took catnaps to get by.
During that time, Bill experienced long depressive periods — but he didn’t recognize them as depression. It wasn’t until he was diagnosed with bipolar disorder at age 50 that he connected his extreme lifestyle to his mental health. Looking back, his friends had noticed his depressive episodes long before he did.
Self-Medicating Sleep Struggles
Like many struggling with sleep and mood instability, Bill turned to alcohol and recreational drugs. “When I was depressed, I’d just assume I partied too hard and was hungover,” he says. To counteract it, he’d use the classic “hair of the dog” approach, further fueling the cycle. Today, Bill no longer drinks or uses drugs and has worked with his doctor to address his sleep issues.
Addressing Sleep Apnea and Medication Side Effects
Bill’s doctor prescribed a mild tranquilizer for occasional use when his mind starts racing. He also learned he has sleep apnea, a condition that can be common in people with bipolar disorder — especially those who gain weight due to medication side effects. Bill himself gained 40 pounds in just six months.
“I’ve tried several times to lose the weight, but I have such trouble getting motivated to exercise,” he admits. “While I’m not losing, at least I’m not gaining anymore.”
According to Maas, the connection between sleep deprivation and weight gain is strong — even without medication-related effects. “So people with bipolar disorder face a double whammy there,” he explains. Fortunately, by prioritizing better sleep habits, Bill has found more stability and energy in his daily life.
The Bipolar and Sleep Connection: Herb’s Story
Herb, who lives in California with his wife, Marilyn, spent much of his life in a manic state, working tirelessly to run his furniture company. But at age 48, he became ill and had to stop working.
It was Marilyn who first noticed his deep, loud snoring and frequent gasping for air. Concerned, she urged him to see a doctor. At the time, Herb had been in a depressive episode for six months, often staying in bed for 12 hours a day. He later realized his sleep apnea was likely contributing to his depression.
“You still feel tired even though you’ve been in bed for a full night,” he explains. “It’s not restful though, because you’re not getting the oxygen you need.”
The Extreme Highs and Lows of Sleep Disruptions
While depression left Herb feeling exhausted despite excessive sleep, mania had the opposite effect. During those periods, he barely slept at all. “There were times I’d stay up till 2:00 or 2:30 a.m. and wake up at 6:00 a.m. with lots of energy,” he recalls. “I’d feel like I could stay up all night typing and write a whole book.”
Recognizing that sleep disruption was fueling his instability, Herb’s psychiatrist adjusted his medications. “At one point, I was on a medication for anxiety and depression that really sped up my system,” he says. His doctor switched him to a different drug and moved his dose to the afternoon instead of nighttime. That way, the energy surge had worn off by bedtime.
Sleep as a Core Feature of Bipolar Disorder
The challenges that both Herb and Bill have faced with sleep are common among people with bipolar disorder. Sleep dysfunction isn’t just a symptom — it’s a key part of the disorder itself.
“We don’t know the underlying reasons, but sleep dysfunction is a core feature of bipolar disorder in both its manic and depressive phases,” explains Susan L. McElroy, MD, professor of psychiatry at the University of Cincinnati College of Medicine. “We always assess for sleep issues in evaluating and treating the disorder. It’s a key therapeutic target to return the person’s sleep to normal.”
Dr. McElroy also dispels the myth that only certain types of insomnia are linked to bipolar disorder. “That’s not true. You can have any type of sleep disruption,” she says. “People have trouble falling asleep, staying asleep, or waking too early. I often see patients with bipolar disorder who stay up late and then struggle to get out of bed in the morning. Essentially, they are hypomanic at night and depressed in the morning. But they don’t notice the mood fluctuations — they notice the sleep issues. Those are easier to recognize.”
For many, addressing sleep problems is a critical first step in stabilizing bipolar disorder.
Treating Bipolar Disorder by Addressing Sleep Issues
When someone with bipolar disorder struggles with sleep, it’s often a sign that their condition is not fully stabilized. “The psychopathological process is still active,” says McElroy. “That person needs proper mood stabilizer treatment. Standard sleep medications might help temporarily, but they will not treat the underlying problem — the bipolar disorder. What will help are mood stabilizers.”
If a person is already on a mood stabilizer and their sleep improves by about 75 percent but still isn’t optimal, they may need a second mood stabilizer. Sleep-correcting drugs can sometimes be part of the treatment plan, but as McElroy explains, “They are only adjuncts, not substitutes, for mood stabilizers. The goal is to get the person’s sleep pattern as normal as possible with minimal use of sleep medication. That’s why we also strongly stress good sleep hygiene.”
Understanding the Role of Medications
People with bipolar disorder sometimes misattribute symptoms of the illness to their medications. “Unfortunately, some of the side effects of the medications are identical to the signs and symptoms of the illness,” McElroy acknowledges. That’s why education and a strong partnership with a knowledgeable psychiatrist are crucial. In some cases, working with a sleep specialist may also be beneficial.
The Universal Benefits of Healthy Sleep Habits
Most people understand the importance of eating well and exercising, but awareness about the role of sleep in overall health is often lacking.
Thorpy encourages people with bipolar disorder to stay physically active, as exercise can improve sleep. “It’s vital to keep active even during a depressive phase,” he says. However, he cautions against exercising strenuously too close to bedtime, as it can be too stimulating. He also stresses the importance of bright light exposure during the day. “Don’t just exercise inside a dark environment. Get outside.”
Sleep experts agree that healthy sleep habits benefit everyone, but for those dealing with major stressors — such as grief, job loss, or a chronic mental health condition — prioritizing sleep hygiene becomes even more critical. “You have to control the factors that you can control,” says Maas. “Sleep is something people with bipolar disorder can and should regularize as much as possible.”
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A Sleep Researcher’s 4 Golden Rules for Restful Nights
Many people struggle to get quality sleep, but for those with bipolar disorder, restless nights can have an even greater impact on health and mood stability. Leading sleep researcher James B. Maas, PhD, shares his four golden rules for getting a good night’s rest.
1. Know What You Need
Determine how much sleep your body requires and meet that need every night. Most adults function best with seven to eight hours, though some need nine to ten hours. If you rely on an alarm clock, struggle to wake up, or feel tired during the day, you’re likely not getting enough sleep.
2. Keep Your Sleep Schedule Consistent
Go to bed and wake up at the same time every day — even on weekends. A regular sleep/wake cycle strengthens your body’s natural rhythms and promotes better rest.
3. Do Not Disturb
Uninterrupted sleep is the most restorative. Set up your environment to minimize disruptions, whether that means using blackout curtains, white noise, or limiting nighttime distractions.
4. Make Up for Lost Sleep
When you miss sleep, recover as soon as possible by going to bed earlier for a few nights or taking short naps (no longer than 30 minutes). Avoid long naps, as they can interfere with nighttime sleep.
By following these simple but powerful rules, anyone — especially those with bipolar disorder — can improve their sleep quality and overall well-being.
Editorial Sources and Fact-Checking
UPDATED: Originally printed as “The Quest for Sleep,” Spring 2006