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Question: How do the length of sleep time and regularity of the sleep schedule affect manic and depressive episodes? Can they be triggers?

Ellen Frank, Ph.D.: Sleep loss can be a trigger for mania. However, if patients and family members keep a close watch on moods and stay on the lookout for manic symptoms, episodes can be prevented or their severity can be decreased.

Sleep loss can be preceded by disruptions in a person’s social rhythms. These disruptions may be associated with serious life events, such as coping with a death in the family or spending the night caring for a very sick child. They may also be caused by less serious events like staying up much of night to watch a movie or finish housework. The stress level of the event does not necessarily indicate whether a person will become manic or how severe the mania will be.

People with bipolar disorder often have internal clocks that are easily thrown off-balance. This makes traveling across time zones or changing one’s work schedule potentially risky. If a person’s clock is thrown off-balance and he or she is deprived of the usual amount of sleep, this can lead to mania.

It’s also important to keep in mind that different people have different needs for sleep. Find out the ideal amount of sleep that you or your loved one need(s) and try to stick to it. If you find you need much more or much less sleep than usual, this may actually be a sign of a manic or depressive episode. If this continues for more than a couple of days, call your health care professional so you can take steps to stabilize your mood before the episode becomes serious.

A regular sleep schedule helps improve the quality of your sleep and how restful it is. Keep in mind that waking up at the same time each day (even on weekends) is more important than going to bed at the same time, though you should do your best to keep both constant. If for some reason, you need to change your sleep schedule, do it gradually. Don’t try to change your going to sleep time or your waking up time by more than 15 minutes per day.

Dr. Frank is Professor of Psychiatry and Psychology at the University of Pittsburgh School of Medicine, and Chair of DBSA’s Scientific Advisory Board.