Bipolar and The Sleep Conundrum:

Since I was a child my sleep patterns have been all over the map. There were times when I would be awake for a long time at night and times, especially as a teenager, where I could easily sleep for fourteen hours. After an episode of psychosis I have been known to sleep long hours, for several months at a time, as my brain rests. It makes sense as I am usually catching up on months (if not years) of insomnia. My body is also adjusting to medication changes. As a person with lived experience of mental illness, this need for long sleep can be frustrating as it impacts many aspects of life. However, while medication can be adjusted to lower drowsiness, it is also important to rest the brain after a bipolar episode that causes insomnia because this is healing for the brain.

Regulating my sleep has been challenging for me. When I experienced my first episode of mental illness, my anxiety and dysregulation was so high that I was often unable to sleep at all. This led to increased paranoia, an inability to function, and a lot of anxiety. This eventually led me to my first hospitalization where they gave me an antipsychotic in hopes of calming down my distress by getting me to sleep.

As I mentioned in an earlier post, this treatment unfortunately led to an allergic reaction because the medication was so potent. If you are someone with a mental illness or a family member of someone with a mental illness, I recommend trying some of the evidence-based approaches to treating insomnia (like Cognitive Behavioural Therapy for Insomnia) because, from my experience, medications are often band-aid solutions when it comes to insomnia. These medications don’t address root causes of sleep disturbances and can make insomnia worse. I understand when they are used in crisis but they are not a long-term solution.

The article, “The Role of Sleep in Bipolar Disorder,” states that there is a high correlation between insomnia and bipolar and that this sleep disturbance has a negative impact on a person with bipolar (Gold and Sylvia, 2016). Sleep disturbance associated with mental illness is also highly correlated with anxiety, substance use, obesity, and lack of exercise (Gold and Sylvia, 2016). Insomnia can occur in mania but also in bipolar depression (Gold and Sylvia, 2016). The article hypothesizes that sleep is part of the root cause of bipolar and that treatment for bipolar would be most effective if it could regulate the sleep disturbance (Gold and Sylvia, 2016).

I think these researchers are right on track for helping a person with bipolar regulate their mood states by improving sleep. It is an important part of a larger puzzle of healing mental illness. Good sleep is part of my compass of recovery.

This research sparked some ideas for helping insomnia. Since sleep disturbance in bipolar is correlated with anxiety (Gold and Sylvia, 2016), anxiety is one root cause of sleep disturbance for bipolar. I know that the number one reason I don’t have a good sleep is if I try to sleep when I have stressful and anxious thoughts on my mind. Having a process to address these concerns before trying to sleep is part of my routine to improve my sleep.

 From anecdotal evidence, many of the people I know who have bipolar also struggle with anxiety. If interventions like therapy, regulating tools (i.e. breathwork or grounding techniques), and meditation are used to treat anxiety, perhaps this would help with bipolar insomnia. Of course, as we’ve explored in other posts, there are many other ways to work with anxiety. Making art as we’ve learned can also help with anxiety

I also see that low physical exercise contributes to sleep disturbance in bipolar (Gold and Sylvia, 2016). I think patients with bipolar disorder sometimes have barriers that prevent them from exercising. If you have bipolar depression, it’s hard to exercise because of low energy and lack of motivation. I also think patients with bipolar are on heavy sedative medications and this makes it very difficult to motivate themselves to move, especially in the morning hours if the medications are given at night. They also might be tired from insomnia due to depression, and this is a barrier for being motivated to exerce. Nevertheless, exercise is crucial for sleeping, generating more energy and creating overall health in the body. In the next post, I will explore in depth about exercise and mental illness.

There are other causes of insomnia related to mental illness. Some psychiatric medications can interfere with sleep, including SSRIs, like Prozac, or benzodiazepines, like Valium. Wellbutrin used for depression, for example, can cause alertness and energy so generally it should be taken in the morning. Please check with your doctor about possible insomnia from medications. I am currently learning that one of my medications that I thought helped sleep, at high doses such as what I am on, can interfere with good sleep. I only found out after I lowered it (with my doctor and I working together) and I slept better.  

Clearly, there are important components to getting sleep when you have bipolar, and these components affect bipolar disorder itself. Addressing anxiety, increasing physical activity, watching for medication side effects causing insomnia, will very likely be beneficial for addressing insomnia in a person with bipolar disorder.

These days I have some trouble regulating my sleep. Either I wake frequently and am tired because of that or I am sleeping so deeply that I feel drowsy in the morning. Typically, I go through a couple days of good sleep and a couple days of wakeful sleep. Lately my sleep has been getting more regular from careful attention with consistency around my sleep schedule and overall sleep hygiene. There are more rare days when I sleep well and feel alert before 10am. This has a large part to do with the medication which I take at night. The slow lowering of the sedative medications should have a positive impact on my sleep quality and how refreshed I am in the morning. I do this carefully under my doctor’s supervision because the effects of withdrawal can be impactful to mental health and dangerous if done too quickly.

Currently I am in bipolar study coming out of the University of Berkeley. They are studying what you eat and when you eat it (i.e. the time you start and finish eating for the day) and its impact on sleep, mood, and overall health benefits. I am not sure if it is the study or the lower of my medications but the last three weeks, I have slept much better as what I eat during the food plan of the study is closer to a Mediterranean diet.

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Typically here are some of my contributors to lack of a good sleep and my solutions:

Thoughts on my mind – worries or just being overstimulated ~Journalling a couple hours before bed, incorporating grounding tools into my night routine and using chamomile tea and magnesium to help my body relax~

Having to use the washroom ~lower liquids at night and go to the bathroom more frequently in the last hour before bed~

Waking after an intense dream ~If I do more processing in the day through journalling, I am less likely to have more disturbing dreams, but my dreaming is not in my control and dreams are natural part of sleeping~

Not tired enough – sleep too much one night and then don’t sleep as well the next ~sticking to consistent bed and wake up times, and making sure I am getting exercise and activity throughout the day~

Heat issues (perimenopause-related) ~Change bedding to breathable sheets and duvets~

It is important if you have insomnia to explore your own sleep barriers. It is also important to note that insomnia can be medical, such as having sleep apnea, so these medical contributors should be ruled out with help from your doctor.

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The role of Cognitive Behavioural Therapy (CBT) and Sleep

Last winter/spring I participated in a CBT for insomnia program. Through detailed tracking of sleep, becoming consistent with bedtime and wakeup times, practicing good sleep hygiene (you can look up this up online to get a list), changing thoughts about sleep, and addressing stress and anxiety, I was able to increase my sleep efficiency. Sleep efficiency is a measure of the quality of sleep. It is calculated from the ratio of time in bed to time asleep and it is measured by a percentage.

One piece of education that was a takeaway from the program was that medications given for sleep do not actually cure insomnia and, in fact, can make things worse. I have been on a slow withdrawal from sleep medication. Initially, the first night or two after a lower, I experience some rebound insomnia and maybe some other symptoms like a feeling of anxiety in my body, but I felt better after these lowers. This is not to suggest that you stop taking sleeping medications. That must be done very slowly and carefully in collaboration with a healthcare practitioner, and you need to implement new strategies to help you sleep. I recommend CBT for Insomnia (CBT-I) groups, which I was able to access for free and was facilitated by a psychiatrist online.  I needed a referral from my doctor.

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Art therapy and Sleep

According to an article titled, “The Ultimate Guide to Art Therapy Activities for Sleep and Restful Nights,” art therapy can help promote sleep in three ways (Scholistico, n.d.). Art Therapy can help sleep by…

1. Reducing anxiety and stress
2. Promoting relaxation
3. Creating a nighttime routine that helps one unwind

According to the research article, “Case Study: Art Therapy for a Client with a Sleep Disorder,” “…art therapy can help with sleep disorders that are primarily connected with mental health issues” (Art Therapy Resources, n.d.).

The article goes on to say that, “Most psychological approaches to sleep disturbances include changing behaviours around sleep, setting sleep goals, developing awareness of triggers, and learning to develop positive relaxation skills. Art therapy can be used effectively in all these approaches to help improve sleep” (Art Therapy Resources, n.d.).

I suggest trying some doodling or colouring before bed to relax and be mindful.

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Okay, are you ready to dive into making some art?🎨

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Therapeutic Arts Activity

I am taking this art therapy activity from the article,” Case Study: Art Therapy for a Client with a Sleep Disorder,” found at the Art Therapy Resources.com website. The goal of this activity is to address worries that contribute to insomnia and promote mindfulness.

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Instructions

Draw a large circle to represent a thought bubble. Inside the thought bubble, draw or write words that represent the issues you are currently feeling anxious about (limit this to about one minute). After this is finished, scribble over the worries or transform this thought bubble into another image to help counteract your worries through art making.

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Materials Needed

• Paper
• Coloured Markers

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Once you’ve completed this activity, here are some questions as guidelines for your personal explorations:

1. Can you identify barriers to your sleep? If so, write them in a journal.

2. What things have been on your mind that might contribute to insomnia?

3. After completing the therapeutic arts exercise, describe how you transformed your image. What resource(s) did you use to transform your worried thoughts?

4. What is one sleep habit you can try changing this week that might improve your sleep?

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In my first picture, I named major worries in my life. Then I transformed it into a balloon that I could set free. I surrounded it with words naming my resources. I gave colour to the black and white original picture and this felt uplifting. Transforming worries and not holding onto them at night is so important for a good night’s sleep and for mental health in general.

 ❤️❤️❤️ With care and kindness, Meegan

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Sources:

Art Therapy Resources. (n.d.).Case Study: Art Therapy for a Client with a Sleep Disorder. https://arttherapyresources.com.au/sleep-disorder/

Gold AK, Sylvia LG. The role of sleep in bipolar disorder. Nat Sci Sleep. 2016 Jun 29;8:207-14. doi: 10.2147/NSS.S85754. PMID: 27418862; PMCID: PMC4935164.

Scholistico. (n.d.) The Ultimate Guide to Art Therapy Activities for Sleep and Restful Nights. https://scholistico.com/ultimate-guide-art-therapy-for-sleep/