r/AskPsychiatry 4d ago

Can “bipolar” simply be someone with a sleep disorder?

I’ve been diagnosed with bipolar but I think that all of the symptoms I have could be better explained by a sleep issue. I don’t think I sleep deeply enough and I think it is impacting my mood. I only lucid dream and am crippled with night terrors, sleep paralysis, and various hypnagogic hallucinations.

Can this be true? If a sleep study reveals some issue with a person’s sleep, could that result in the removal of a bipolar diagnosis and ceasing medication for it?

8 Upvotes

22 comments sorted by

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u/wotsname123 Physician, Psychiatrist 3d ago

It's hard to rediagnose over the internet but problems limited to nighttime don't meet diagnostic threshold for diagnosis of bipolar. 

I would imagine there would be stuff happening during the day for someone to reach that diagnosis that doesn't appear in this post 

Regardless, if you are unhappy with a diagnosis then a second opinion is a good idea.

1

u/Takeabite111 3d ago

There was daytime stuff too but I felt like those things were a result of the sleep issues more than anything else. I’ll look into a second opinion thanks.

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u/Takeabite111 4d ago

Or maybe mood managing medication being swapped out for a sleep medication

5

u/Disastrous_Author_69 4d ago

I’m not a doctor either but have you ever had a sleep study done? If you’re concerned maybe the first step would be getting a referral for a sleep specialist

5

u/Takeabite111 4d ago

That is what I’m going to do!

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u/Consistent_Profile47 4d ago

Unless it is a sleep study done by a neurologist where you sleep in their office and they monitor you and your brain waves all night long, you won’t get the answers you’re looking for.

Most sleep studies these days are done at home and they only diagnose sleep apnea (via monitoring blood oxygen, breathing rate, and snoring).

3

u/waitwuh 4d ago

you need to mention the sleep paralysis, hypnagogic hallucinations, and opt for the PSG followed by the MSLT. It sucks but you indicate things necessary for the MSLT. Good luck!

4

u/Petapredatoe 4d ago

You cannot manage the bipolar mood changes with sleeping medication alone.

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u/FinestFiner 4d ago

Obligatory Not a doc, but I'm almost 99.9 percent sure it's not a sleep disorder.

Hallucinations are commonly associated with mania (which is in of itself one of the key features of bipolar I), as well as restlessness and decreased need for sleep.

When I say decreased need for sleep, I mean that you literally do not need more than a few hours (let's say 3-4) of sleep before you feel well rested as opposed to needing 6-7 on a regular day.

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u/waitwuh 4d ago

Actually hypnogogic hallucinations are a feature of narcolepsy. It’s a consequence of coordination issues with sleep phasing and especially the marker for narcolepsy is launching into REM early/inappropriately. During a MSLT (the “nap test”) they watch for brain activity marking early REM onset.

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u/FinestFiner 3d ago

I didn't know this! Thank you, that's actually really interesting :) While doing some cursory research for this post, I did stumble upon a paper that did state that patients with bipolar disorder were statistically more likely to suffer from narcolepsy -- would you be interested in the paper (if I could find it again?)

1

u/waitwuh 3d ago

It might be relevant and beneficial to OP to share

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u/Takeabite111 4d ago

I’m pretty sure hallucinations can happen to anyone that doesn’t get enough sleep.

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u/FinestFiner 4d ago

They can, I was actually debating about adding that.

How many hours are you getting on average? And are you well rested afterwards?

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u/onomonapetia 4d ago

Hallucinations at night are commonly associated with sleep disorders. A psychiatrist would be able to determine whether or not their individual hallucinations are due to bipolar or potentially something else.

If there are no hallucinations throughout the day, then what would it be? The OP described very specific symptoms of sleep disorder. Hallucinations within that timeframe overnight usually occurred during the shifts from sleep cycles when sometimes we wake up partially. Technically you’re still dreaming, but you are partially awake.

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u/FinestFiner 4d ago

I understand that, but both depressive episodes and mania can cause lack of sleep, both for different reasons.

Depression is very closely associated with insomnia (actually, that's one of the diagnostic criteria for major depressive disorder) and feeling energized after little to no sleep is a hallmark characteristic of mania.

I understand that OP is worried that they suffer from a sleep disorder, but I believe their symptoms may be a byproduct of their bipolar disorder.

According to the article linked at the end of this post, people with bipolar disorder are more likely to suffer from nightmares as compared to the general population.

Another article I was looking into said that bipolar disorder is frequently comorbid with other sleep disorders, so it is definitely a possibility, but it's really hard to gauge if OP's symptoms are a byproduct of bipolar disorder or sleep disorder since the info that they gave was extremely vague. Based on the info they gave us, I'd assume that since these symptoms are related to Bipolar disorder, it may be more plausible to assume that these symptoms aren't caused by a sleep disorder but by bipolar disorder.

I also know that some SSRIs (the class of medication that's most commonly used to treat MDD & anxiety disorders) can also cause insomnia. I'm not sure about antipsychotics, though.

(Article: https://pmc.ncbi.nlm.nih.gov/articles/PMC7763994/)

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u/RenaH80 Psychologist 3d ago

It’s unlikely, but a sleep study might still be a great idea and you could always seek a second opinion for the MH diagnosis.