If you have bipolar I, you’re probably familiar with the emotional peaks and valleys that the condition is characterized by. “With bipolar disorder type I, the person either gets very, very depressed or they get very, very high on what we call a manic state,” Ludmilla De Faria, MD, a psychiatrist specializing in bipolar disorder and an associate professor of psychiatry at the University of Florida, tells SELF.
According to Dr. De Faria, mania is pretty unmistakable. Manic episodes, which sometimes include psychosis symptoms like hallucinations and delusions, can become so intense that they lead to hospitalization. A person experiencing a manic episode might be “talking very fast, they don’t need to sleep, they’re doing 500 things at the same time, they’re very grandiose,” Dr. De Faria says.
She adds that the triggers that can lead to a manic or depressive episode in people with bipolar I are often more difficult to identify than the symptoms themselves. One particular trigger is especially elusive because it’s such a normal part of life. That trigger is sleep disruption: a period when someone gets less sleep than usual or has poor sleep hygiene, affecting the quality of their rest.1
“It is very well documented that not sleeping enough hours by itself can trigger an episode, without any other issues,” Dr. De Faria says.1 For someone with bipolar I, even a short stretch of disrupted sleep can be enough to trigger mania. “Lack of sleep is not a good thing in general,” she says. “Sleep is a period when the brain resets and reorganizes, and I like to say it files away important information that you came across during the day. The inability to engage in that on a regular basis can eventually be very problematic.”
Research supports the link between sleep disruption and bipolar I episodes—and more specifically, manic periods. A 2019 study found an overall connection between problems with sleep, daytime sleepiness, and bipolar disorder2, and a 2017 study found that people with bipolar I (especially women) were more susceptible to sleep loss as a trigger for manic episodes.3
According to Dr. De Faria, issues with getting rest are so tough to identify as a trigger because we’re socially conditioned to think that missing out on sleep in certain situations is normal—like if you’re a student working hard in the lead-up to finals, or if you’re partying on a fabulous vacation in Mykonos, or you’re staying up late and waking up early to show a manager you deserve a promotion at work.
On top of that, poor sleep can also pair up with other factors that may trigger a bipolar I episode, like stressful life events or changes in medication. For example, what looks like overachieving behavior, or even maintaining a strong work-life balance as a person raising children and trying to advance their career, can potentially signal the beginning of a bipolar I episode. “People think, ‘Well, look at her, she’s having it all and she’s really successful, so why would I interfere?’” Dr. De Faria says. But the symptoms of full-blown mania that disrupt someone’s life (say they’re having extreme delusions, or they’re staying up all night every night) might not be apparent until months later, when more intensive treatment and hospitalization could become necessary in order for a person to recover.