48-Hour Sleep-Wake Cycles in Manic-Depressive Illness: Naturalistic Observations and Sleep Deprivation Experiments
Abstract
Wrist motor activity and sleep were monitored longitudinally in 15 rapidly cycling and 52 nonrapidly cycling manic-depressive patients. The majority of patients experienced one or more consecutive 48-hour sleep-wake cycles (alternate nights with no sleep) when they switched out of depression into mania of hypomania. During a depressive phase, nine rapidly cycling patients were asked to simulate a 48-hour sleep-wake cycle by remaining awake for 40 hours (one night's total sleep deprivation). Eight switched out of depression, and seven were rated as manic or hypomanic; indicating that sleep loss (such as occurs with spontaneous 48-hour sleep-wake cycles) may help to trigger switches from depression to mania. The 48-hour sleep-wake cycles in patients may depend on a mechanism that is normally present in all humans, since normal persons also spontaneously experience near-48 hour sleep-wake cycles in certain experimental conditions.
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In bipolar disorder, episodes of mania and depression are accompanied by dramatic changes in the timing and duration of sleep.
“In bipolar disorder, episodes of mania and depression are accompanied by dramatic changes in the timing and duration of sleep1–4.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [4]
Sleep is abnormally long in depression and abnormally short in mania, and it is often completely absent during switches from depression to mania.
“Sleep is abnormally long in depression and abnormally short in mania, and it is often completely absent during switches from depression to mania4.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [4]
Disrupting sleep of bipolar patients can induce mania and restoring sleep can induce depression.
“Experiments have shown that disrupting sleep of bipolar patients can induce mania and restoring sleep can induce depression4–8.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [4]
Switches from depression into mania were accompanied by one or more nights of total insomnia.
“The switches from depression into mania were also accompanied by one or more nights of total insomnia (Figs. 1 and 5).”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [4]
Being awake or being asleep during a circadian interval that normally coincides with sleep in the second half of the sleep period will determine whether the patient subsequently will be manic or depressed, respectively.
“These results can be summarized as showing that being awake or being asleep during a circadian interval that normally coincides with sleep in the second half of the sleep period will determine whether the patient subsequently will be manic or depressed, respectively2–8.”
From Bipolar mood cycles associated with lunar entrainment of a circadian rhythm (2018) · cites this paper as [4]
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References 24 · Cited by 217
- Authors
- Wehr, T. A.
- Affiliations
- National Institute of Mental Health (US)
- Corresponding author
- Wehr, Thomas A.
- ORCID
- Wehr, Thomas A.
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 1982-05-01
- Volume
- 39
- Issue
- 5
- Pages
- 559
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2051525211
- Cited by
- 217
- References
- 24
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 3 · 2023: 5 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 4 · 2017: 8 · 2016: 6 · 2015: 8 · 2014: 6 · 2013: 5 · 2012: 6
- FWCI
- 7.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- bipolar disorder, rapid cycling, sleep deprivation, mania, hypomania, depression, circadian rhythm
- MeSH terms
- Adult, Bipolar Disorder, Female, Humans, Lithium, Male, Middle Aged, Motor Activity, Periodicity, Sleep, Sleep Deprivation, Antipsychotic Agents, Wakefulness, Lithium Carbonate
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