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The role of sleep in bipolar disorder

Authors Gold A, Sylvia L

Received 25 February 2016

Accepted for publication 18 April 2016

Published 29 June 2016 Volume 2016:8 Pages 207—214

DOI https://doi.org/10.2147/NSS.S85754

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Prof. Dr. Roumen Kirov

Peer reviewer comments 3

Editor who approved publication: Professor Steven Shea

Alexandra K Gold,1 Louisa G Sylvia,1,2

1Department of Psychiatry, Massachusetts General Hospital, 2Harvard Medical School, Boston, MA, USA

Abstract: Bipolar disorder is a serious mental illness characterized by alternating periods of elevated and depressed mood. Sleep disturbances in bipolar disorder are present during all stages of the condition and exert a negative impact on overall course, quality of life, and treatment outcomes. We examine the partnership between circadian system (process C) functioning and sleep–wake homeostasis (process S) on optimal sleep functioning and explore the role of disruptions in both systems on sleep disturbances in bipolar disorder. A convergence of evidence suggests that sleep problems in bipolar disorder result from dysregulation across both process C and process S systems. Biomarkers of depressive episodes include heightened fragmentation of rapid eye movement (REM) sleep, reduced REM latency, increased REM density, and a greater percentage of awakenings, while biomarkers of manic episodes include reduced REM latency, greater percentage of stage I sleep, increased REM density, discontinuous sleep patterns, shortened total sleep time, and a greater time awake in bed. These findings highlight the importance of targeting novel treatments for sleep disturbance in bipolar disorder.

Keywords: bipolar disorder, circadian rhythms, sleep–wake homeostasis

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