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Sleep disturbance has long been recognized as an essential aspect of bipolar disorder. The relationship between sleep and the manic phase of bipolar illness involves the following aspects: decreased need for sleep is a marker of mania; sleep deprivation can induce mania; sleep duration may predict manic episodes; and sleep time may be a marker of response in mania. Although less is known about sleep disturbance in bipolar as compared to unipolar depression, this chapter highlights the phenomenology of sleep in bipolar depression and the potential of sleep deprivation as a theraputic strategy in the depressive phase of bipolar illness. Euthymia, the absence of mood symptoms sufficient to warrant the diagnosis of a depressive, hypomanic, or manic episode, is the goal of treatment of bipolar disorder. It has long been appreciated that bipolar disorder tends to run in families, suggesting it is a heritable disorder.
Sleep-related complaints are extremely common across the spectrum of psychiatric illness. Accurate diagnosis and management of sleep disturbances requires an understanding of the neurobiological mechanisms underlying sleep and wakefulness, the characteristics of sleep disturbance inherent to psychiatric illness and primary sleep disorders, as well as the psychopharmacologic and behavioral treatments available. Foundations of Psychiatric Sleep Medicine provides a uniquely accessible, practical, and expert summary of current clinical concepts at the sleep-psychiatry interface. Topics covered include: basic principles in sleep science, clinical sleep history taking, primary sleep disorders in psychiatric contexts, and sleep disturbance across a range of mood, anxiety, psychotic, substance use, cognitive and developmental disorders. Written by outstanding experts in the field of sleep medicine and psychiatry, this academically rigorous and clinically useful text is an essential resource for psychiatrists, psychologists and other health professionals interested in the relationship between sleep and mental illness.
This chapter discusses future clinical and research directions in psychiatric sleep medicine. Older models in which sleep complaints were assumed to be caused by an underlying psychiatric disorder are insufficient to explain the more complex interrelationships between sleep and mental illness. Pharmacotherapies at the nexus of sleep medicine and psychiatry are slowly moving from agents discovered largely through serendipity to those developed using translational approaches due to an enhanced understanding of the processes involved in the regulation of sleep and the pathophysiology of sleep disorders. One of the greatest challenges faced at the interface of psychiatry and sleep medicine is the need for communication between the fields of addiction, eating disorder, and obesity research. Without a common language to classify sleep disorder, it becomes a significant challenge to communicate findings from one field to researchers in the other.