Individuals with bipolar disorder who got less sleep than normal experienced a higher level of impulsive behavior and other symptoms the next day, according to a study published in Journal of Affective Disorders.

In between manic and depressive episodes, symptoms including disturbed sleep and impulsivity remain. Both these symptoms can predict the onset of bipolar disorder. The researchers investigated these core bipolar disorder features as potential risk factors for bipolar disorder.

Using a naturalistic, ecological momentary assessment (EMA) design, the study examined participants at high risk for bipolar disorder as well as a few with early-onset bipolar disorder. Participants were a subset of a previous study called Project TEAM. They ranged between 18 and 27 years of age at the time of the study. Out of a total of 107 participants at high risk for bipolar disorder, 43 developed the condition at some point during the follow-up period, and 3 were taking prescribed psychotropic medication during the study. The participants completed self-reported assessments and a clinical diagnostic interview at baseline and symptom measures and other ratings during the study.


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The researchers found significant cross-level interactions between impulsivity, sleep disturbances, and circadian rhythm patterns and next-day mood symptoms. They found those with higher total sleep time and low impulsivity ratings experienced lower next-day hypomanic symptoms. Participants with higher impulsivity ratings and higher total sleep time experienced slightly higher hypomanic symptoms. There was a cross-level interaction between sleep onset latency and next-day hypomanic symptoms. Negative urgency and dim-light melatonin onset (DLMO) time were connected with higher next-day depressive symptoms.

While the study had several strengths, it examined only mood symptoms and not episodes. Future studies over a longer time period should examine this trait, the researchers stated. A larger sample size may also yield clinically significant information.

“The present study provides evidence that impulsivity may combine with sleep and circadian rhythm alterations to increase bipolar symptoms among individuals at high-risk for or with recent-onset BSD,” the researchers conclude.

“Our results support the need for more longitudinal research to examine the role of impulsivity in influencing the dynamic relationship between sleep and circadian alterations and bipolar symptoms.”

Reference

Titone MK, Goel N, Ng TH, MacMullen LE, Alloy LB. Impulsivity and sleep and circadian rhythm disturbance predict next-day mood symptoms in a sample at high risk for or with recent-onset bipolar spectrum disorder: an ecological momentary assessment study. J Affect Disord. 2022;298(Pt A):17-25 doi:10.1016/j.jad.2021.08.155