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Default May 10, 2021 at 10:26 AM
  #1
I'm sorry if this has been asked before. I understand the relation between mania/depression and sleep disturbances, but my insomnia issues appear to persist even in between episodes. I've heard many more people mention this. Can anyone shed some more light on why bipolar seems to cause sleep issues even outside episodes, and what are some of the best ways to improve sleep (without sleep meds)? Why can't I sleep like a normal person when I'm not having an episode?

For what it's worth, I'm already keeping a steady sleep schedule, not drinking caffeine, avoiding screen time in the evenings, and using my bed only for sleep. I still wake up after a few hours and have trouble getting back to sleep. My next plan is to try running every morning, even though I hate running, because I hear the early daylight + exercise is good for your circadian rhythm. I'm open to any other advice.
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Default May 10, 2021 at 10:47 AM
  #2
@FluffyDinosaur:

That's interesting, what you wrote about early daylight + exercise being good for circadian rhythm. Hopefully someone will be along shortly with some tips for you as i am never euthymic and just hop from oversleeping to under-sleeping. Sounds like you're making all the right moves, to me. Sorry i don't have anything to add.
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Default May 10, 2021 at 11:04 AM
  #3
I don’t know about you, but I’ve got a mutation in a gene called clock that basically controls circadian rhythm....my sleep is actually too long though, but I suspect that other people with bipolar may have similar mutations but in different circadian rhythm genes and with different effects. So if your circadian rhythm is broken even sunlight won’t help.

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Default May 10, 2021 at 12:10 PM
  #4
Thank you both!

@Sometimes psychotic: I hope that's not the case for me! Just out of curiosity, at what age did your sleep issues start? I used to sleep better when euthymic, so I hope that means things can still get better for me.
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Default May 10, 2021 at 12:50 PM
  #5
I wish I could help with some suggestions. I never had any sleep issues until my first child was born. Since then, sleep has never been the same for me. By the time I was 30 I was taking medication to sleep and have done so for all these years. I've always required a lot of sleep, and to my knowledge I've never experienced the lack of need for sleep that bipolar disorder is supposed to sometimes cause (which could be due to being medicated). But, my sleep is always broken - although I seldom have difficulty falling back to sleep after I've been up and about for awhile.


The biggest problem I've had with sleep is when I don't take a med to sleep. Then I experience that miserable feeling of being somewhat awake while I'm asleep.

So what I'm trying to say is that I believe medication affects my sleep (causes me to need a lot of sleep). Were I not on meds I don't know how my sleep would be.

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Default May 10, 2021 at 02:20 PM
  #6
Not sleeping between episodes I've been told by doctors is a sleep disorder - completely separate from my bipolar 2. I was told it would get worse as I got older, and he was right.

But there sure seems to be a hell of a lot of people with bipolar disorder with crippling insomnia regardless of their mood state -so

I would oversleep during depressive episodes until my early thirties, but otherwise I started struggling with insomnia as early as 6 years old. It got worse the older I got. But in my early 30s insomnia started to rule, regardless of mood. I did all the right things, and the long list of commonly and not so commonly known sleep hygeine became my way of life. NOTHING WORKED!

I spent 5 years addicted to zopiclone - the happiest most well rested and productive years of my life. And then zopiclone was no longer prescribed long term and I went into shocking withdrawl that lasted several months.

For the next 11 years, terrified of taking something addictive, and terrified of the weight gain and side effects of an anti-psychotic - my life grew smaller and smaller., and SI was a constant companion. Many times I went to work on only 45 minutes sleep. In those 11 years I did not sleep more than 4 hours a night - except on 2 occasions.

Two years ago I admitted defeat and asked to be prescribed seroquel. It was the best decision I"d made in years. I sleep now - a few days each month my peri-menopause overpowers the seroquel - but my life has vastly improved.

I never, never would have slept without medication. I did everything, everything under the sun to sleep without meds and nothing worked. I regret wasting so much time fearing the side effects of an AP.
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Default May 10, 2021 at 02:32 PM
  #7
i am not sure about why that is the case, perhaps this is something worth asking to your doctor or pdoc? i agree with the other wise and wonderful posters about wishing i could Help with some suggestions. i do think that what you're dong to improve your sleep, such as running early in the morning can prove rather useful. So Sorry if this post isn't useful but i don't have much to add. Sending many safe, warm hugs to ALL of you, @FluffyDinosaur, your Families, your Friends and ALL of your Loved Ones! Keep fighting and keep rocking NO MATTER WHAT HAPPENS, OK?!
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Default May 10, 2021 at 03:50 PM
  #8
I’ve had trouble sleeping my whole life. When I was young I had ....oh I forget what it’s called but I would wake up screaming and wake everybody in the house. I used to get in the middle of the bed with my head between the two pillows and the sheets and comforters had to be completely flat. I had to be exactly in the middle and if I fell asleep before my parents turned out the lights I could sleep ok, or if I didn’t fall asleep before lights out I had to stay awake all night to keep the demons at bay. Or so I believed. From my first hospitalization to this day I’m on massive doses of sleep meds. And still I struggle to sleep. So I don’t know what the answer is but I wasn’t BP until my early 20s so the two may not be related.

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Default May 10, 2021 at 09:59 PM
  #9
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Originally Posted by FluffyDinosaur View Post
Thank you both!

@Sometimes psychotic: I hope that's not the case for me! Just out of curiosity, at what age did your sleep issues start? I used to sleep better when euthymic, so I hope that means things can still get better for me.
I’ve slept at least ten hours from birth.....12 on AP. When manic though it’s two hours or less a night. Odds are if you had a circadian issue you would have seen it before the onset of bipolar.

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Default May 11, 2021 at 03:00 AM
  #10
Thanks for the replies everyone!

I agree that I've heard from so many bipolar people with sleep issues that I'm having a little trouble believing that in all those cases it's just a coincidence. My feeling is that there's just something about bipolar disorder and a messed up circadian rhythm.

I was on Seroquel for a while, and slept very well on it. I loved that about it, I never had to worry about sleeping soundly. Currently I'm not using Seroquel, and I feel pretty strongly about not going back on an anti-psychotic unless I absolutely have to, for health reasons. However, if nothing else I try works and the alternative is a lifetime of insomnia, then I'll consider going back to a low dosage of Seroquel. For now, though, I think there's still more I can try.

I was never a great sleeper, I always used to wake up frequently and was very sensitive to the switch to daylight saving time every year. But it definitely used to be better than this. I could always get back to sleep fairly easily, even though I did wake up a lot. Like some others here have mentioned, the worst of my insomnia started around my late twenties/early thirties, and especially when I had kids. Now I tend to wake up and then be unable to get back to sleep, or only a half sleep, even when there's no noise or anything from kids. It's like a part of my brain just "activates," and I can't do anything about it regardless of how much I try relaxation exercises or sleep hygiene stuff (it feels so unfair). I also had ****** neighbors for a few years who were noisy at night and wreaked havoc on my sleep. Luckily we've now moved to a new house where it's better, so far, but I still tend to be a little paranoid about people making noise at night. Hopefully that will fade over time.

When I was in my early puberty I went through several time periods where I would have sleep paralysis every night for a few weeks. I would wake up after a few hours and be unable to move, and I would see all kinds of scary stuff. I didn't know what sleep paralysis was at the time, so it was pretty scary and I was afraid to sleep. I had several periods of a few weeks like that, on and off for a few years, and then it went away. I haven't had it now for a long time.

At this point I guess the early morning daylight/running strategy is my best bet, so I'll try that in addition to my regular sleep hygiene approach. I also have C-PTSD issues in addition to my bipolar, which I think I can try to work on with my therapist now that I'm finally approaching something like euthymia again. Before, the bipolar symptoms were just so severe and acute that it overruled everything else. Maybe dealing with some of the traumatic stuff that happened last year, as well as childhood stuff, will also help with sleep and stress levels. I only hope that these sleep issues don't trigger a relapse and undo all the progress I made with ECT, because I'm so happy to finally feel almost like myself again...
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Default May 11, 2021 at 03:21 AM
  #11
I don't know that this is a purely bipolar situation. I always slept beautifully when not some level of manic. Or if purely depressed, I usually had hypersomnia. This is pre-meds.

I take 600 mg of Seroquel XR at night, but that's for moodstabilization. If I stopped it, I am certain I would have insomnia because when I miss it, or take it very late, I don't sleep, but I see that as withdrawal insomnia. It's not an addictive med, but I am dependent on it, in a sense. I would likely become manic without it, or on too small of a dose. Maybe that sounds like insomnia between episodes, but I don’t think that would be accurate, really. In any case, I may never know if/how things would be different without it. I can say that on a proper dose of Seroquel XR, and my other bipolar meds, I sleep beautifully when stable. Right now I regard myself as stable, but lowered energy. I slept at least 9 (maybe 10) hours last night with only a brief wakeup at 5:30 am for a drink of water. Then I slept again until almost 8 am. I went to bed fairly early. This much sleep is a bit abnormal for me. I usually get 8 hours. I've been abnormally tired lately.

If you've had insomnia most of your life, outside of episodes, I would bet my money on what lightlytoasted wrote. It might be a sleep disorder separate from bipolar disorder.

Last edited by Soupe du jour; May 11, 2021 at 04:42 AM..
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Default May 11, 2021 at 06:15 AM
  #12
Good question... And unfortunately, I don't have an answer.

I just know that I've had trouble falling asleep since I was teenager, and at that time got little sleep. I would sleep for some 12 hours on weekends.

In my 20's, when Bipolar symptoms started to rear their ugly head, I still wasn't sleeping, unless, of course, I abused the Klonopin I was on, usually in conjunction with a great deal of alcohol (I was an alcoholic for many many years). However, it wasn't always to sleep, there were some intentional overdoses in there.

In any case, these days, lack of sleep is my biggest trigger for Bipolar episodes, so my pdoc prescribes meds for sleeping and if I have just a little trouble at some point, she will increase them, such is the fear I will go doolally, as I put it. I currently take 50 mg of Seroquel to sleep and 1mg of Klonopin for anxiety, but that also helps me sleep, especially in conjunction with the Seroquel. Now, if I were not to be able to sleep with these meds, if I were to have break-through insomnia, I KNOW I'm going into an episode. I don't fall asleep on these meds, it's more like passing out.

I wish I knew if chronic insomnia had something to do with Bipolar Disorder, if nothing else then out of curiosity. All I know is that I need to be knocked out at night, that with those meds I have to go to bed very very early to not be hungover the next day, as well as to not be symptomatic. Ugh, sleep has always been such an issue with me!

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Default May 11, 2021 at 07:33 AM
  #13
@Soupe du jour: Yes, I definitely see what you mean. However, I wouldn't say I've had insomnia most of my life. I was never a great sleeper, but it used to at least be "good enough" (except for the sleep paralysis now and then) and I never considered it a major issue until the last few years. The interesting thing (to me) is that the worsening of my bipolar disorder and my inter-episode insomnia seemed to go hand in hand. So I don't know, but it still feels to me like there may be some sort of connection.

@Gabyunbound: I'm sorry to hear about your OD experiences. Unfortunately I had some incidents of my own during my most recent episode, when I was so far gone that it's hard to believe it when I think back about it now. In my case there was no alcohol involved, but mainly benzos. They remain tempting for sleep, but I try to minimize using them and so far I've fortunately managed to avoid addiction. But what I mean is, I think I can relate to your experiences, at least somewhat.

Lack of sleep is a major trigger for my episodes as well, which is part of why it scares me so much and why I'm so desperate to improve my sleep. I know from experience that Seroquel XR 50mg works well for me, too, in terms of sleep. I also know from experience that it has a mood-stabilizing effect for me, even at relatively low dosages (it seems like I'm very sensitive to Seroquel for some reason). If nothing else works, I guess it's good to have that as a backup option, and I hope the side effects won't be too bad at 50mg. When I was last on it, it was mainly drowsiness, but I don't know what it did to my cholesterol and so on. What are your experiences in that regard?
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Default May 11, 2021 at 09:17 AM
  #14
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Originally Posted by FluffyDinosaur View Post
Lack of sleep is a major trigger for my episodes as well, which is part of why it scares me so much and why I'm so desperate to improve my sleep. I know from experience that Seroquel XR 50mg works well for me, too, in terms of sleep. I also know from experience that it has a mood-stabilizing effect for me, even at relatively low dosages (it seems like I'm very sensitive to Seroquel for some reason). If nothing else works, I guess it's good to have that as a backup option, and I hope the side effects won't be too bad at 50mg. When I was last on it, it was mainly drowsiness, but I don't know what it did to my cholesterol and so on. What are your experiences in that regard?
I can say that at doses of 500 mg and above, of Seroquel XR, my cholesterol and sometimes my triglycerides were elevated. But they never were on Seroquel XR (or regular Seroquel) at doses lower than that, or when I was younger. There's no way for me to know how a small dose of Seroquel would affect you, but I'm guessing that a small dose wouldn't hurt me that much, if at all.

I am getting older (50), and have a family history of high cholesterol and triglycerides, even among a couple members who never took psych meds and had normal BMIs. Some who were very overweight, and middle-aged, did have high cholesterol and similar issues, but so does the general population. It's hard to know, really. I know that when I reached a normal BMI and took at least 350 mg Seroquel XR, 160 mg Geodon, and 900 mg Lithium (at the same time), I had perfect blood work. I'm about 15 to 18 lbs overweight now, and could use some exercise.

I take a statin and blood pressure meds. I know my blood pressure is normal on the meds. I don't know about my cholesterol & triglycerides. Even if they aren't much improved, I'd say that taking Seroquel XR, for me, is the MUCH better option than not.
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Default May 11, 2021 at 09:21 AM
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Originally Posted by Soupe du jour View Post
I can say that at doses of 500 mg and above, of Seroquel XR, my cholesterol and sometimes my triglycerides were elevated. But they never were on Seroquel XR (or regular Seroquel) at doses lower than that, or when I was younger. There's no way for me to know how a small dose of Seroquel would affect you, but I'm guessing that a small dose wouldn't hurt me that much, if at all.

I am getting older (50), and have a family history of high cholesterol and triglycerides, even among a couple members who never took psych meds and had normal BMIs. Some who were very overweight, and middle-aged, did have high cholesterol and similar issues, but so does the general population. It's hard to know, really. I know that when I reached a normal BMI and took at least 350 mg Seroquel XR, 160 mg Geodon, and 900 mg Lithium (at the same time), I had perfect blood work. I'm about 15 to 18 lbs overweight now, and could use some exercise.

I take a statin and blood pressure meds. I know my blood pressure is normal on the meds. I don't know about my cholesterol & triglycerides. Even if they aren't much improved, I'd say that taking Seroquel XR, for me, is the MUCH better option than not.

Thank you, that's very encouraging!
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Default May 11, 2021 at 08:24 PM
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Just curious...do you take any type of antidepressant at nighttime?

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Default May 11, 2021 at 10:06 PM
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Just curious...do you take any type of antidepressant at nighttime?
Thanks, no, all I take at the moment is Lamictal, and I take that in the morning.
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Default May 12, 2021 at 08:45 AM
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@Soupe du jour: Yes, I definitely see what you mean. However, I wouldn't say I've had insomnia most of my life. I was never a great sleeper, but it used to at least be "good enough" (except for the sleep paralysis now and then) and I never considered it a major issue until the last few years. The interesting thing (to me) is that the worsening of my bipolar disorder and my inter-episode insomnia seemed to go hand in hand. So I don't know, but it still feels to me like there may be some sort of connection.

@Gabyunbound: I'm sorry to hear about your OD experiences. Unfortunately I had some incidents of my own during my most recent episode, when I was so far gone that it's hard to believe it when I think back about it now. In my case there was no alcohol involved, but mainly benzos. They remain tempting for sleep, but I try to minimize using them and so far I've fortunately managed to avoid addiction. But what I mean is, I think I can relate to your experiences, at least somewhat.

Lack of sleep is a major trigger for my episodes as well, which is part of why it scares me so much and why I'm so desperate to improve my sleep. I know from experience that Seroquel XR 50mg works well for me, too, in terms of sleep. I also know from experience that it has a mood-stabilizing effect for me, even at relatively low dosages (it seems like I'm very sensitive to Seroquel for some reason). If nothing else works, I guess it's good to have that as a backup option, and I hope the side effects won't be too bad at 50mg. When I was last on it, it was mainly drowsiness, but I don't know what it did to my cholesterol and so on. What are your experiences in that regard?
It seems we have a lot in common! Though I am so happy you haven't had trouble with alcohol; it wreaked so much chaos and misery in my life...

In any case, I haven't had my cholesterol checked in a long time, so I don't know if the 50mg has affected it. For some reason I had in my head that only higher doses of it caused such problems, but now from what you said I'm not so sure. I tend to eat too much and not well, but I get addicted so easily (now to certain foods) it's hard to parse out what might be the seroquel and what might just be me. Though, now that I think of it, I'm not sure my desire to eat has changed since being put back on Seroquel (years ago, after a particularly nasty manic episode, I was put on high doses of seroquel for a while, which did affect my eating and cholesterol).

At 50 mg plus the klonopin (unfortunately, I can't tell you what it's like to take that dose without Klonopin along with it) I literally PASS OUT within the hour. I have to be very careful as to when I take them, because I know, if I were to try to stay awake I would be a dribbling fool, and in any case, it would be futile. So the combination is extremely effective (though 25mg had to be upped to 50mg several months ago due to breakthrough insomnia). But also, I HAVE to get tons of sleep on this combo if I'm going to be at least somewhat coherent the following day. I go to bed very early, get about 10 hours of sleep, and still at times have trouble getting up to my alarm.

I wish you luck with sleep! I guess, ultimately, I can recommend Seroquel for sleep. Just monitor eating and cholesterol in case these are affected, and make sure you get enough sleep/go to bed early.

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Default May 13, 2021 at 05:05 AM
  #19
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It seems we have a lot in common! Though I am so happy you haven't had trouble with alcohol; it wreaked so much chaos and misery in my life...

In any case, I haven't had my cholesterol checked in a long time, so I don't know if the 50mg has affected it. For some reason I had in my head that only higher doses of it caused such problems, but now from what you said I'm not so sure. I tend to eat too much and not well, but I get addicted so easily (now to certain foods) it's hard to parse out what might be the seroquel and what might just be me. Though, now that I think of it, I'm not sure my desire to eat has changed since being put back on Seroquel (years ago, after a particularly nasty manic episode, I was put on high doses of seroquel for a while, which did affect my eating and cholesterol).

At 50 mg plus the klonopin (unfortunately, I can't tell you what it's like to take that dose without Klonopin along with it) I literally PASS OUT within the hour. I have to be very careful as to when I take them, because I know, if I were to try to stay awake I would be a dribbling fool, and in any case, it would be futile. So the combination is extremely effective (though 25mg had to be upped to 50mg several months ago due to breakthrough insomnia). But also, I HAVE to get tons of sleep on this combo if I'm going to be at least somewhat coherent the following day. I go to bed very early, get about 10 hours of sleep, and still at times have trouble getting up to my alarm.

I wish you luck with sleep! I guess, ultimately, I can recommend Seroquel for sleep. Just monitor eating and cholesterol in case these are affected, and make sure you get enough sleep/go to bed early.

Okay, thanks for your input, I appreciate it! I agree that Seroquel can hit pretty hard, more like knocking me out than gently putting me to sleep. It's kind of inconvenient if you have early-morning obligations the next day, but if it's the only way then it certainly beats not sleeping. I'll make sure to keep an eye on my cholesterol if I do decide to restart Seroquel!
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Default May 13, 2021 at 06:26 AM
  #20
Another thought: has anyone here experimented with a biphasic sleep pattern? I've read several articles that say that research shows that's actually natural for humans. Maybe I should just try embracing the idea of sleeping for a few hours, then waking up and reading a book for an hour or so instead of fighting to get back to sleep, and then sleeping some more when I'm tired enough again. Who knows, I might even come to enjoy it. It should certainly be more enjoyable than lying in bed growing increasingly desperate because I can't sleep. Maybe without the stress caused by that despair, falling asleep again for a second cycle will be easier. Any thoughts?

Last edited by FluffyDinosaur; May 13, 2021 at 07:40 AM..
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