Sleep Deprivation and BP Disorder 4/30/00
Treatments for Bipolar Disorder and Other Disorders ��� Sleep deprivation treatment must take into account the type of depression, as evidence suggests that it produces different effects depending on the form of depression.� For example, total sleep deprivation causes better improvements in mood for bipolar and single-episode patients compared with unipolar depression. Within the spectrum of bipolar disorders, bipolar I patients respond more frequently than bipolar II patients. The role of sleep deprivation in bipolar disorder is discussed below. �
Bipolar Disorder ���� Bipolar disorder (the medical name for manic depression) affects approximately 1% of adults in the United States.� It is in the same family as clinical depression, although unlike depres! sion, is affects equal numbers of men and women. Bipolar disorder is characterized by bouts of mania followed by bouts of depressions.� Usually shifts from one state to another are quite gradual. ��� Recurring cycles have cumulative deteriorating effects on both the functioning of the individual and his or her response to treatment,� and thus rapid diagnosis and treatment is essential. It has been estimated that, on average,� early treatment results in a 7 years gain on life. Lithium, anticonvulsant drugs, and electroconvulsive therapy are usually used to treat the manic episodes and show efficacy in 60-80% of patients. The depressive episodes are treated in a manner similar to clinical depression. Sleep deprivation can cause depression to remit and thus can be used as alternative to drugs. Although there is little response to sleep deprivation early in the depressive episode, there is usually a very large response late in an episode, often leading to its ter! mination.� Duration of antidepressant response to sleep deprivation o ften increases linearly as time into the episode increases. These results suggest that neurochemicals in the brain that underlying depression may change over the course of an episode, resulting in an increased responsivity to sleep deprivation later compared with earlier in the course of an episode. �
Further evidence for the role of sleep deprivation in bipolar disorder comes form animal studies of sleep deprivation.� It has been shown that the end of the period of sleep deprivation, the rat does not fall asleep as soon as it is returned to the home cage but rather stays awake for 30 minutes during which time it displays symptoms similar to mania including insomnia, hyperactivity, irritability, aggressiveness, and hypersexuality. � �
Switch from Depression to Mania ��� Sleep deprivation therapy must be used with caution - termination of a depressive episode often leads to the manic episode.� Clinical investigations indicate that disrupted sleep can t! rigger and intensify mania, and bipolar patients may be especially vulnerable to mania/hypomania after disrupted sleep or sleep deprivation. In fact, most patients switching out of depression into mania experience one alternate night with no sleep. Additionally, in clinical tests, bipolar patients in a depressive phase asked to remain awake for 40 hours will switch out of depression to mania. It has also been suggested that sleep deprivation per se does not trigger mania but rather the changes in the timing of sleep relative to other circadian rhythms. �
Other Disorders ��� The effects of sleep deprivation has been examined in anxiety disorders, obsessive-compulsive disorder, social phobia, and panic disorder, but overall has failed to improve symptoms of these patients.� In fact, sleep deprivation seems to worsen symptoms in about 40% of cases of patients suffering from panic di! sorder and anxiety disorder. Right now it appears, with the exception of premenstrual dysphoric disorder, that the therapeutic effects of sleep deprivation may be specific to depression and may therefore be a biological marker distinguishing major depression from other anxiety disorders. ___________________________________________________ Sleep Loss Can Trigger Mania
NEW YORK (Reuters) -- Disruption in sleep may be dangerous for people with bipolar disorder, also known as manic depression. A new study suggests that sleep disturbances may trigger an episode of mania, in which individuals lose touch with reality, need little sleep or food, have enormous amounts of energy, and are easily triggered into states of rage or paranoia.
Bipolar disorder is characterized by such episodes -- periods of mania, where someone is overly optimistic and might start an ambitious, impossible-t! o-finish project, or invest their life savings in a risky venture -- alternating with episodes of severe depression and lethargy. About 2 million people in the U.S. suffer from bipolar disorder.
"For reasons we have yet to learn, people with bipolar disorder seem to have more delicate internal clock mechanisms," said Dr. Ellen Frank, professor of psychiatry and psychology at the University of Pittsburgh Medical Center's Western Psychiatric Institute and Clinic.
"Staying up all night to watch television, working into the wee hours to study or catch up on work, or spending the night in the emergency room with a sick child may all act as a springboard into mania," said Frank, who is a co- author of the study. "The level of stress that causes the sleep loss doesn't seem to make much difference."
In a study of 39 people with bipolar disorder, Frank and colleagues found that 65% of patients had at least one disruption in their d! aily rhythm in the two months before the onset of a manic or depressi ve episode.
In contrast, only 20% of the same patients had a disruption in sleep or schedule in a two-month period prior to relatively calm time during the same year, according to the study that is scheduled to be presented at the Second International Conference on Bipolar Disorder in Pittsburgh. A loss of sleep seemed to make the biggest difference between those who had a manic episode and those who remained on an even keel. Even a single night of sleep loss may be enough to exacerbate mental illness, according to the Pennsylvania researcher.
"We believe that we need to help people with this illness develop a sound routine in order to help protect their biological clocks from disturbances," Frank said. "It's important to remember that while patients need to lead more regular lives, that doesn't mean they need to live boring lives."
The researchers hope that their findings will help in the discovery of new ways to treat patients w! ith bipolar disorder. In the meantime, family members need to be attuned to the warning signs of an oncoming manic episode, including gradual reduction in sleep or increase in irritability. Medication can help patients avoid the episodes of mania or depression.
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