Skip to main content Accessibility help
×
Home

Sleep and circadian rhythm disturbance in bipolar disorder

  • A. J. Bradley (a1) (a2), R. Webb-Mitchell (a1), A. Hazu (a1), N. Slater (a1), B. Middleton (a3), P. Gallagher (a1), H. McAllister-Williams (a1) (a4) and K. N. Anderson (a5)...

Abstract

Background

Subjective reports of insomnia and hypersomnia are common in bipolar disorder (BD). It is unclear to what extent these relate to underlying circadian rhythm disturbance (CRD). In this study we aimed to objectively assess sleep and circadian rhythm in a cohort of patients with BD compared to matched controls.

Method

Forty-six patients with BD and 42 controls had comprehensive sleep/circadian rhythm assessment with respiratory sleep studies, prolonged accelerometry over 3 weeks, sleep questionnaires and diaries, melatonin levels, alongside mood, psychosocial functioning and quality of life (QoL) questionnaires.

Results

Twenty-three (50%) patients with BD had abnormal sleep, of whom 12 (52%) had CRD and 29% had obstructive sleep apnoea. Patients with abnormal sleep had lower 24-h melatonin secretion compared to controls and patients with normal sleep. Abnormal sleep/CRD in BD was associated with impaired functioning and worse QoL.

Conclusions

BD is associated with high rates of abnormal sleep and CRD. The association between these disorders, mood and functioning, and the direction of causality, warrants further investigation.

Copyright

Corresponding author

*Address for correspondence: Dr K. N. Anderson, Regional Sleep Service, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK. (Email: kirstie.anderson@nuth.nhs.uk)

References

Hide All
Aldhous, ME, Arendt, J (1988). Radioimmunoassay for 6-sulphatoxymelatonin in urine using an iodinated tracer. Annals of Clinical Biochemistry 25, 298303.
American Academy of Sleep Medicine (2014). International Classification of Sleep Disorders. American Academy of Sleep Medicine: Darien, Illinois.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.
Beck-Friis, J, von Rosen, D, Kjellman, BF, Ljunggren, JG, Wetterberg, L (1984). Melatonin in relation to body measures, sex, age, season and the use of drugs in patients with major affective disorders and healthy subjects. Psychoneuroendocrinology 9, 261277.
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Butt, M, Dwivedi, G, Khair, O, Lip, GY (2010). Obstructive sleep apnea and cardiovascular disease. International Journal of Cardiology 139, 716.
Buysse, DJ, Reynolds, CF III, Monk, TH, Berman, SR, Kupfer, DJ (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research 28, 193213.
Eidelman, P, Talbot, LS, Gruber, J, Harvey, AG (2010). Sleep, illness course, and concurrent symptoms in inter-episode bipolar disorder. Journal of Behavior Therapy and Experimental Psychiatry 41, 145149.
Geoffroy, PA, Scott, J, Boudebesse, C, Lajnef, M, Henry, C, Leboyer, M, Bellivier, F, Etain, B (2014). Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies. Acta Psychiatrica Scandinavica 131, 8999.
Giglio, LM, Magalhaes, PV, Andreazza, AC, Walz, JC, Jakobson, L, Rucci, P, Rosa, AR, Hidalgo, MP, Vieta, E, Kapczinski, F (2009). Development and use of a biological rhythm interview. Journal of Affective Disorders 118, 161165.
Harvey, AG (2008). Sleep and circadian rhythms in bipolar disorder: seeking synchrony, harmony, and regulation. American Journal of Psychiatry 165, 820829.
Harvey, AG, Schmidt, DA, Scarna, A, Semler, CN, Goodwin, GM (2005). Sleep-related functioning in euthymic patients with bipolar disorder, patients with insomnia, and subjects without sleep problems. American Journal of Psychiatry 162, 5057.
Harvey, AG, Soehner, AM, Kaplan, KA, Hein, K, Lee, J, Kanady, J, Li, D, Rabe-Hesketh, S, Ketter, TA, Neylan, TC, Buysse, DJ (2015). Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial. Journal of Consulting and Clinical Psychology 83, 564577.
Horne, JA, Ostberg, O (1976). A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. International Journal of Chronobiology 4, 97110.
Johns, MW (1991). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14, 540545.
Jones, SH, Hare, DJ, Evershed, K (2005). Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder. Bipolar Disorders 7, 176186.
Kanady, JC, Soehnera, AM, Harvey, AG (2015). A retrospective examination of sleep disturbance across the course of bipolar disorder. Journal of Sleep Disorders & Therapy 4, 214222.
Kaplan, KA, Gruber, J, Eidelman, P, Talbot, LS, Harvey, AG (2011). Hypersomnia in inter-episode bipolar disorder: does it have prognostic significance? Journal of Affective Disorders 132, 438444.
Kelly, T, Douglas, L, Denmark, L, Brasuell, G, Lieberman, DZ (2013). The high prevalence of obstructive sleep apnea among patients with bipolar disorders. Journal of Affective Disorders 151, 5458.
Kennedy, SH, Kutcher, SP, Ralevski, E, Brown, GM (1996). Nocturnal melatonin and 24-hour 6-sulphatoxymelatonin levels in various phases of bipolar affective disorder. Psychiatry Research 63, 219222.
Kushida, CA, Littner, MR, Morgenthaler, T, Alessi, CA, Bailey, D, Coleman, J Jr., Friedman, L, Hirshkowitz, M, Kapen, S, Kramer, M, Lee-Chiong, T, Loube, DL, Owens, J, Pancer, JP, Wise, M (2005). Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep 28, 499521.
Lam, RW, Berkowitz, AL, Berga, SL, Clark, CM, Kripke, DF, Gillin, JC (1990). Melatonin suppression in bipolar and unipolar mood disorders. Psychiatry Research 33, 129134.
Michalak, EE, Murray, G (2010). Development of the QoL.BD: a disorder-specific scale to assess quality of life in bipolar disorder. Bipolar Disorders 12, 727740.
Millar, A, Espie, CA, Scott, J (2004). The sleep of remitted bipolar outpatients: a controlled naturalistic study using actigraphy. Journal of Affective Disorders 80, 145153.
Minors, DS, Waterhouse, JM (1988). Mathematical and statistical analysis of circadian rhythms. Psychoneuroendocrinology 13, 443464.
Nelson, HE (1982). National Adult Reading Test (NART): Test Manual. NEFR-Nelson: Windsor.
Ng, TH, Chung, KF, Ho, FY, Yeung, WF, Yung, KP, Lam, TH (2015). Sleep-wake disturbance in interepisode bipolar disorder and high-risk individuals: a systematic review and meta-analysis. Sleep Medicine Reviews 20, 4658.
Novakova, M, Prasko, J, Latalova, K, Sladek, M, Sumova, A (2015). The circadian system of patients with bipolar disorder differs in episodes of mania and depression. Bipolar Disorders 17, 303314.
Nurnberger, JI Jr., Adkins, S, Lahiri, DK, Mayeda, A, Hu, K, Lewy, A, Miller, A, Bowman, ES, Miller, MJ, Rau, L, Smiley, C, Davis-Singh, D (2000). Melatonin suppression by light in euthymic bipolar and unipolar patients. Archives of General Psychiatry 57, 572579.
Robillard, R, Naismith, SL, Rogers, NL, Scott, EM, Ip, TK, Hermens, DF, Hickie, IB (2013). Sleep-wake cycle and melatonin rhythms in adolescents and young adults with mood disorders: comparison of unipolar and bipolar phenotypes. European Psychiatry 28, 412416.
Rosa, AR, Sanchez-Moreno, J, Martinez-Aran, A, Salamero, M, Torrent, C, Reinares, M, Comes, M, Colom, F, Van Riel, W, Ayuso-Mateos, JL, Kapczinski, F, Vieta, E (2007). Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice & Epidemiology in Mental Health 3, 5.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 2233; quiz 34–57.
Soreca, I, Buttenfield, JA, Hall, MH, Kupfer, DJ (2015). Screening for obstructive sleep apnea in patients with bipolar I disorder: comparison between subjective and objective measures. Bipolar Disorders 17, 345348.
Souetre, E, Salvati, E, Belugou, JL, Pringuey, D, Candito, M, Krebs, B, Ardisson, JL, Darcourt, G (1989). Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality. Psychiatry Research 28, 263278.
Spielberger, CD, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA (1983). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists Press: Palo Alto, CA.
Talbot, LS, Stone, S, Gruber, J, Hairston, IS, Eidelman, P, Harvey, AG (2012). A test of the bidirectional association between sleep and mood in bipolar disorder and insomnia. Journal of Abnormal Psychology 121, 3950.
te Lindert, BH, Van Someren, EJ (2013). Sleep estimates using microelectromechanical systems (MEMS). Sleep 36, 781789.
van Hees, VT, Sabia, S, Anderson, KN, Denton, SJ, Oliver, J, Catt, M, Abell, JG, Kivimaki, M, Trenell, MI, Singh-Manoux, A (2015). A Novel, Open Access Method to Assess Sleep Duration Using a Wrist-Worn Accelerometer. PLoS ONE 10, e0142533.
Van Someren, EJ, Swaab, DF, Colenda, CC, Cohen, W, McCall, WV, Rosenquist, PB (1999). Bright light therapy: improved sensitivity to its effects on rest-activity rhythms in Alzheimer patients by application of nonparametric methods. Chronobiology International 16, 505518.
Walters, AS, LeBrocq, C, Dhar, A, Hening, W, Rosen, R, Allen, RP, Trenkwalder, C (2003). Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Medicine 4, 121132.
Williams, JB, Kobak, KA, Bech, P, Engelhardt, N, Evans, K, Lipsitz, J, Olin, J, Pearson, J, Kalali, A (2008). The GRID-HAMD: standardization of the hamilton depression rating scale. International Clinical Psychopharmacology 23, 120129.
Wulff, K, Joyce, E, Middleton, B, Dijk, DJ, Foster, RG (2006). The suitability of actigraphy, diary data, and urinary melatonin profiles for quantitative assessment of sleep disturbances in schizophrenia: a case report. Chronobiology International 23, 485495.
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429435.

Keywords

Type Description Title
WORD
Supplementary materials

Bradley supplementary material
Figure S1

 Word (28 KB)
28 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed