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-to-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 daily rhythm in the two months before the onset of a manic or depressive 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 with 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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