Child and Adolescent Psychiatric Clinics of North America
The Adverse Consequences of Sleep Disturbance in Pediatric Bipolar Disorder: Implications for Intervention
Section snippets
Sleep in youth with bipolar disorder
Table 1 presents an overview of the studies that have reported the nature and extent of sleep disturbance in children and teenagers with bipolar disorder. Overall, the data suggest that sleep disturbance is a prominent feature of bipolar disorder in youth, although it is notable that only a handful of these studies were explicitly conducted to investigate sleep. Hence, much of our existing knowledge is derived from studies examining other aspects of the disorder in which sleep also happened to
Consequences of Sleep Disturbance for Youth with Bipolar Disorder
There are several lines of evidence indicating that sleep disturbances represent a critical issue for the functioning of youth with bipolar disorder. Moreover, data are beginning to emerge in support of the hypothesis that sleep disturbances may contribute mechanistically to the core pathophysiology of pediatric bipolar disorder—a little-studied but potentially very important line of investigation, which could inform early treatment approaches. Several aspects of the relationship between sleep
Current options and practices for treatment of sleep disturbance in children and adolescents (broadly, not focusing on bipolar disorder)
There is robust evidence for the use of a psychological intervention, cognitive behavior therapy (CBT), for treating adults with sleep disturbance.58 The research literature on the treatment of sleep disturbance with psychological interventions in children and adolescents is small but promising as are the data on the behavioral and/or emotional improvements after the treatment of sleep problems in children and adolescents.59, 60, 61, 62 For example, Bootzin and colleagues63 developed a
Current options and practices for treatment of sleep disturbance in adults with bipolar disorder
To the best of the author's knowledge, there are no clinical trials of interventions for sleep disturbance in adults with bipolar disorder (or in youth with bipolar disorder). However, several of the psychological adjunctive interventions for bipolar disorder include one or more components targeting sleep. Interpersonal and social rhythm therapy includes instruction in behavioral techniques designed to regularize routines and reduce social rhythm disruption.66 CBT provides education about the
Toward a psychological intervention for sleep disturbance in youth with bipolar disorder
Given the prevalence of sleep disturbance among youth with bipolar disorder, the associated adverse consequences, and the lack of empirically tested treatments, a high priority for future research is to develop an intervention for the sleep disturbance experienced by youth with bipolar disorder. An intervention for sleep may be particularly acceptable to youth as the payoffs of improving sleep are immediate, and sleep is often perceived by patients to be an aspect of health that is free of the
Summary
Sleep disturbance in youth with bipolar disorder is critically important, yet surprisingly understudied. We have reviewed evidence on the prevalence and nature of sleep disturbance in youth with bipolar disorder. Evidence pointing to the importance of sleep includes that sleep disturbance appears to be an early marker for bipolar disorder; is a distinguishing feature of pediatric bipolar disorder; contributes to relapse, affect dysregulation, and deficits in cognitive functioning; and may also
Acknowledgments
The author gratefully acknowledges David Axelson, Natasha Dagys, Ron Dahl, Anda Gershon, Tina Goldstein, Steve Hinshaw, and Ben Mullin for helpful discussions relating to the content covered in this article.
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Sleep alterations in pediatric bipolar disorder versus attention deficit disorder
2019, Psychiatry ResearchCitation Excerpt :In this context, sleep studies, together with a greater understanding of the underlying neurophysiological substrate, could provide a theoretical framework to elucidate the etiopathogenesis of pediatric BD and to develop new strategies for the diagnosis and treatment of this condition (Harvey, 2009; Milhiet et al., 2011; Steiger and Kimura, 2010).
Developmental pathways towards mood disorders in adult life: Is there a role for sleep disturbances?
2019, Journal of Affective DisordersCitation Excerpt :Growing evidence has been accumulated for mood disorders to arise in part from abnormal malfunction of the timing within and between the circadian system and human behaviour (for an overview see Harvey 2009; Harvey 2011; Wulff et al., 2010; MClung 2013). The “circadian hypothesis of mood disorders” has suggested that there is disruption between endogenous rhythms controlled by de-synchronization of the body clock suprachiasmatic nuclei, the master biological clock of the hypothalamus and social zeitgebers such as personal relationships, caring responsibilities, work, travel, timing of outdoor activities, physical exercise or meals, which all have the potential to weaken the circadian internal phase regularity (for an overview see Foster and Wulff 2005; Harvey 2009; Harvey 2011; McClung 2013; Dallaspezia and Benedetti 2011). Rhythmic clock-controlled gene expression regulates multiple monoaminergic brain regions that control mood and motivated behaviors, stress and inflammatory systems, reward circuits, arousal and sleep by interacting with the homeostatic regulation of sleep and wake (Wulff et al., 2010; McClung 2013).
Sleep in Children With Psychiatric Disorders
2015, Seminars in Pediatric NeurologyCitation Excerpt :Similar to adults, the role of circadian rhythm dysfunctions has been implicated in the pathophysiology of pediatric bipolar disorder in the form of significantly lower levels and later onset of melatonin secretion.31 Sleep disturbance is also considered as an early marker for the onset and progression of bipolar disorder in youth who have a family history of bipolar disorder32; moreover, the presence of continued sleep disturbance is thought to contribute to relapse of episodes.33 Sleep disturbances in youth with bipolar disorder is often characterized by increased sleep-onset latency, multiple nighttime awakenings, variable total sleep time (TST) duration, greater total time awake during these nighttime awakenings, and decreased need for sleep.34,35
Psychosocial interventions in the treatment of youth diagnosed or at high-risk for pediatric bipolar disorder: A review of the literature
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