Sleep as a Signal in Bipolar Disorder
Why monitoring sleep patterns may help clinicians detect mood episodes sooner
Bipolar disorders are mental health conditions where a person’s mood swings between high-energy states (like feeling overly excited or irritable) and low-energy states (like feeling very sad or hopeless).
Bipolar disorders include:
Bipolar I: Involves at least one manic episode, often followed by depressive or hypomanic episodes.
Bipolar II: Involves at least one major depressive episode and one hypomanic episode, but no full manic episodes.
Cyclothymic Disorder: Characterized by prolonged periods of subclinical mood symptoms that don’t meet full criteria for hypomania or major depression.
Mania vs. Hypomania:
Both mania and hypomania can include feeling unusually happy or irritable, having more energy, sleeping less, talking more, and being easily distracted. The difference is in severity and duration:
Mania lasts at least 7 days (or any amount of time if hospitalization is needed) and may include serious symptoms like delusions or hallucinations.
Hypomania is milder, lasts at least 4 days, and doesn’t include psychotic symptoms.
The Predictive role of sleep
A new review published in the Journal of Affective Disorders analyzed findings from 13 prospective studies, drawing on data from more than 7,000 records. Researchers found that changes in sleep patterns often foreshadow mood episodes, making sleep a promising early warning marker for clinicians and clients alike. More specifically, researchers found that:
Longer sleep duration and later wake times often preceded depressive episodes.
Shorter sleep and earlier rising tended to come before manic or hypomanic episodes.
These findings emerged from a variety of data collection methods, including:
Actigraphy: A wearable device that tracks movement to estimate sleep and wake cycles.
Ecological Momentary Assessments (EMA): Real-time self-reports collected throughout the day, which can offer a more accurate and context-rich picture of behavior and mood than traditional recall-based methods.
One interesting takeaway is that many individuals with bipolar disorder reported that sleep disruptions are their first clue that something is shifting. In studies cited by the review, between 53–90% of participants identified sleep changes as an early sign of mania, more so than mood symptoms themselves.
The link between sleep and depression was weaker than for mania, but still clinically meaningful, suggesting that sleep patterns may serve as an early indicator of depressive episodes as well.
Clinical Takeaways
Relapse is common in bipolar disorder, with nearly 40% of individuals experiencing multiple episodes within five years. This makes early detection and proactive management essential. Here are some ways clinicians can apply these insights in practice:
Provide Psychoeducation: Help clients understand that sleep is not just a symptom, but a potential early warning signal. Educate them on how shifts in sleep, such as sleeping longer or waking earlier than usual, can precede mood episodes. Consider using visual tools, handouts, or mood-sleep tracking worksheets (many available online) to reinforce learning and engagement. This website has links to handouts and worksheets. And in scanning for the disorder, you can use tools such as the Mood Disorder Questionnaire.
Track collaboratively: Normalize and simplify daily monitoring. Encourage clients to use user-friendly tools like the eMoods app, which allows individuals with bipolar disorder to log sleep, mood, medication, and more. Tracking may work best when it’s integrated into treatment planning and reviewed regularly.
Act Early, Act Together: Treat emerging sleep changes as meaningful clinical data, not just secondary symptoms. If patterns suggest a shift toward mania or depression, bring this into collaborative discussion. When appropriate, coordinate with the client’s psychiatrist or prescribing provider, especially since medications like lithium or mood stabilizers may need adjusting
Build Self-Awareness Over Time: Encourage clients to reflect not just on how they feel, but how they’re sleeping. As awareness grows, many clients learn to spot their own patterns, and use this insight to seek support earlier in the cycle.
Attribution: This summary was created by the team at Psychvox and is based on insights from the article “Do sleep variables predict mood in bipolar disorder: A systematic review” by Andrea Ulrichsen and colleagues. All rights to the original research remain with the authors and the publisher. This summary is intended for educational purposes only and does not imply endorsement by the original authors. The article is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0).