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Cited by 26Sleep and related disordersBipolar Disorder and TreatmentCircadian rhythm and melatonin

Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

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Geoffroy, P.A., Micoulaud Franchi, J.-A., Lopez, R., Poirot, I., Brion, A., Royant-Parola, S., Etain, B.·2017·L'Encéphale
DOI 10.1016/j.encep.2016.06.007
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Abstract

Objectives Sleep complaints are very common in bipolar disorders (BD) both during acute phases (manic and depressive episodes) and remission (about 80 % of patients with remitted BD have poor sleep quality). Sleep complaints during remission are of particular importance since they are associated with more mood relapses and worse outcomes. In this context, this review discusses the characterization and treatment of sleep complaints in BD.Methods We examined the international scientific literature in June 2016 and performed a literature search with PubMed electronic database using the following headings: "bipolar disorder" and ("sleep" or "insomnia" or "hypersomnia" or "circadian" or "apnoea" or "apnea" or "restless legs").Results Patients with BD suffer from sleep and circadian rhythm abnormalities during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal and/or early awakenings, non-restorative sleep) and manic episodes (insomnia, decreased need for sleep without fatigue), but also some of these abnormalities may persist during remission. These remission phases are characterized by a reduced quality and quantity of sleep, with a longer sleep duration, increased sleep latency, a lengthening of the wake time after sleep onset (WASO), a decrease of sleep efficiency, and greater variability in sleep/wake rhythms. Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness, sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS), and restless legs syndrome (RLS). These disorders are insufficiently diagnosed and treated whereas they are associated with mood relapses, treatment resistance, affect cognitive global functioning, reduce the quality of life, and contribute to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities have been also associated with suicidal behaviors. Therefore, a clinical exploration with characterization of these abnormalities and disorders is essential. This exploration should be helped by questionnaires and documented on sleep diaries or even actimetric objective measures. Explorations such as ventilatory polygraphy, polysomnography or a more comprehensive assessment in a sleep laboratory may be required to complete the diagnostic assessment. Treatments obviously depend on the cause identified through assessment procedures. Treatment of chronic insomnia is primarily based on non-drug techniques (by restructuring behavior and sleep patterns), on psychotherapy (cognitive behavioral therapy for insomnia [CBT-I]; relaxation; interpersonal and social rhythm therapy [IPSRT]; etc.), and if necessary with hypnotics during less than four weeks. Specific treatments are needed in phase delay syndrome, OSAHS, or other more rare sleep disorders.Conclusions BD are defined by several sleep and circadian rhythm abnormalities during all phases of the disorder. These abnormalities and disorders, especially during remitted phases, should be characterized and diagnosed to reduce mood relapses, treatment resistance and improve BD outcomes.

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Authors
Geoffroy, P. A., Micoulaud Franchi, J.-A., Lopez, R., Poirot, I., Brion, A., Royant-Parola, S., & Etain, B.
Affiliations
  • Inserm (FR)
  • Centre Hospitalier Universitaire de Lille (FR)
Corresponding author
Geoffroy, P.A.
ORCID
Venue
L'Encéphale
Publisher
Elsevier BV
Published
2017-08
Volume
43
Issue
4
Pages
363-373
ISSN
0013-7006 (ISSN-L)
DOI
10.1016/j.encep.2016.06.007
OpenAlex
W2525121079
Cited by
26
References
57
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 3 · 2020: 6 · 2019: 3 · 2018: 2 · 2017: 2
FWCI
0.31
Type
journal article
Language
fr
Open access
Licence
Locations
  • L Encéphale (publishedVersion)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, other-oa)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords
bipolar disorder, sleep complaints, insomnia, hypersomnia, circadian rhythm disruption, delayed sleep phase syndrome, obstructive sleep apnea-hypopnea syndrome, restless legs syndrome, comorbid sleep disorders, sleep quality, actigraphy, sleep questionnaires, cognitive function, metabolic syndrome, weight gain, hypnotics, psychotherapy
MeSH terms
Bipolar Disorder, Circadian Rhythm, Humans, Sleep Wake Disorders

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