Working with Sleep Difficulties in Bipolar Disorder

Sleep disturbances are commonplace in bipolar disorder, and successful management of the illness often requires interventions tailored to specific sleep complaints. In this chapter, we provide an overview of treating sleep disturbance in bipolar disorder via behavioral sleep interventions. We first present background research on the complex relationship between bipolar disorder and various sleep disturbances such as insomnia (i.e., difficulty initiating or maintaining sleep), hypersomnia (i.e., excessive daytime sleep or sleepiness), reduced need for sleep, and circadian rhythm dysfunction (e.g. delayed sleep phase). Next, we discuss the importance of treating sleep disturbance in bipolar disorder and discuss recent advances in behavioral sleep treatments as well as their efficacy among patients with bipolar disorder. We describe recommended assessment techniques, a method for case formulation, behavioral, and cognitive interventions for various sleep disturbances and specific practice tips. Illness-specific considerations such as episode relapse, medication challenges, and unhelpful beliefs about sleep are reviewed, as is an emergent literature on diversity considerations in behavioral sleep treatments. We provide a thorough case example illustrating application of sleep techniques and conclude with future directions for research.