Poor Sleep and Mood Closely Intertwined in People With Bipolar Disorder

Woman with bipolar disorder symptom in flat design. Bipolar patient with mood swings sometimes in a good mood sometimes sad.
Researchers used the ecological momentary assessment, actigraphy, and self-reported sleep measures to examine the relationship of sleep and mood in people with bipolar disorder.

People with bipolar disorder (BD) who reported poor sleep exhibited more sadness and anger than those who slept normally according to a study published in Psychiatric Research.

The researchers used the ecological momentary assessment (EMA), actigraphy, and self-reported sleep measures to examine the relationship of sleep and mood in people with BD. They recruited participants from a longitudinal study on aging in people diagnosed with BD. The participants completed assessments annually. Sleep patterns were tracked using wrist-worn actigraphy devices. The study included 56 participants: 22 who used 1 assessment and 34 who received 2 or more assessments annually.

The researchers found that more variable sleep onset time was associated with worse mean mood ratings (anger, anxiety, impulsivity) and more variable ratings of anger. Waking after sleep onset was associated with more variable ratings of anxiety and greater mean impulsivity. Those with higher impulsivity during the day slept worse that same night, and those who sleep poorly felt worse the next day.

The study used a small sample including participants with varying sleep issues. The participants also all experienced relatively stable symptoms, so the results may not apply to the entire BD population.

“Future EMA studies of the sleep-mood relationship in BD should include subjective and objective sleep assessments for a more comprehensive understanding of this connection,” the researchers state. “Further, additional research is required to confirm which aspects of mood are associated with sleep the previous night and vice versa.


Patapoff M, Ramsey M, Titone M, et al. Temporal relationships of ecological momentary mood and actigraphy-based sleep measures in bipolar disorder. J Psychiatr Res. 2022;150:257-263. doi:10.1016/j.jpsychires.2022.03.055