Assessment and treatment of sleep problems in bipolar disorder—A guide for psychologists and clinically focused review

Abstract

Sleep problems are highly prevalent in bipolar disorder (BD) and constitute an important therapeutic focus in this population: They are highly impairing and distressing, are an area of subjective importance to consumers, and likely play a role in predicting/triggering mood episodes. The aim of this review is to orient psychologists and psychotherapists to current research relevant to their clinical practice with people with BD, including (a) the prevalence and presentation of sleep problems, (b) the impacts and correlates of impaired sleep, and (c) the relationship between sleep problems and mood symptoms (including the predictive/triggering role of sleep in BD mood relapses). Detailed recommendations for assessment and cognitivebehavioural intervention strategies for use in BD are described. It will be concluded that although some sleep problems and comorbidities require interdisciplinary collaboration, a range of evidence-informed strategies can be effectively and appropriately applied by clinical psychologists and psychotherapists. K E Y W O R D Sbipolar disorder, circadian, mood disorder, psychiatric disorder, self-management, sleep

Maintaining Daily Routines to Stabilize Mood: Theory, Data, and Potential Intervention for Circadian Consequences of COVID-19

“…Circadian explanations for illness genesis and vulnerability are common in psychiatry but have been most prominent in mood disorders where marked disturbances of circadian rhythms (the measurable physiological, cognitive, or behavioral processes exhibiting the approximately 24-hour imprint of the circadian system ) are evident before, during, and after episodes of illness. 3 –7 As concluded in recent reviews, a range of evidence triangulates on the conclusion that circadian abnormalities are part of the pathogenic cascade to mood disorder. 8,9…”

“…Consequently, clinicians working with mood disorders need to be attentive to sleep components of their patient’s presentation and where necessary elevate sleep problems as targets of clinical attention in their own right. 4 Attention to other aspects of daily routines such as mealtimes and regular social activities may also be an important aspect of mood stabilization for those with mood disorders.…”

The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

“…Sleep and mood have a bidirectional relationship, and from a circadian health perspective, stabilisation of daily routines (as prescribed within IPSRT, for example) requires that any problems with sleep itself be addressed first. Consequently, clinicians working with mood disorders need to be attentive to sleep components in their patient’s presentation and where necessary elevate sleep problems as targets of clinical attention in their own right (Fang et al, 2019; Morton and Murray, 2020b; Wang et al, 2019).…”

Sleep Interventions in the Treatment of Schizophrenia and Bipolar Disorder

“…Clinical interview or, including the opinions of the family, self-report scales, sleep diary, and sleep monitoring methods such as actigraphy can be used to determine the sleep problems of this patient group ( 27 ). In clinical interview, some complaints which are frequently encountered in these patients such as difficulty falling asleep, excessive daytime sleepiness, snoring, apnea, abnormal sleep behavior should be questioned.…”