Insomnia Treatment Can Mitigate Symptoms in People With Bipolar Disorders

Laura Palagini, MD, PhD

Investigative research has linked insomnia symptoms to weakened resilience in individuals with bipolar disorder and alludes to potential associations with early life stressors. Additionally, investigators believe that these relationships likely impact mood and suicide risk.

Aside from being a prevalent psychiatric diagnosis, bipolar disorder (BD) is a chronic condition that can be debilitating and as a result, exacerbates the global burden of diability and morbidity. Laura Palagini, MD, PhD, University of Ferrara, Department of Neuroscience and Rehabilitation, Ferrara, Italy, and investigators stated that understanding the involved mechanisms to better identify early markers should be prioritized.

Insomnia plays a prominent role in the onset and management of bipolar disorder as symptoms affecting the circadian sleep cycle are principle presentations in both diseases. Patients with depressive disorders tend have low resilience which influences the severity of bipolar disorder and risk of suicide.

The Relationship of Insomnia and Bipolar Disorder

Because insomnia is also suspected to be a factor of reduced resiliency, investigators aimed to evaluate the association between the conditions in 188 patients with a diagnosis of either bipolar disorder type I or II. The participating patients were experiencing a depressive phase during the study period.

Investigators utilized the Structural Clinical Interview for DSM-5 (SCID-5), the Beck Depression Inventory-II (BDI-II), Young Mania Rating Scale (YMRS), Early Trauma Inventory Self Report-Short Form (ETISR-SF), Resilience Scale for Adults (RSA), Insomnia Severity Index (ISI), and the Scale for Suicide Ideation (SSI).

Since stressors in early life could potentially affect an individual's resilience and vulnerability to bipolar disorder, this relationship was included the the study's analysis. Investigators compared patients with or without clinically significant insomnia to identify correlations.

Insomnia Mediates Resilience, Depression and Suicide Risk

According to the regression and mediation analyses, those with insomnia demonstrated an increased severity of depressive symptoms, suicidal risk, early life stressors, and lower levels of resilience. The associations between low resilience and early life stressors; low resilience in future-planning and depressive symptoms; and low resilience and increased suicial risk, all appeared to be mediated by insomnia symptoms.

These data indicate insomnia's significant connection to bipolar disorder, specifically in regard to severity of the disease, the occurrence of early life stressors, and decreased resilience in this population. The consequence of these associations is exhibited by the negative effect on mood symptoms and increased vulnerability to suicidal risk.

In acknowledgement of the findings, investigators emphasized the need to prioritize further understanding of insomnia symptoms in individuals with bipolar disorders with the objective of implementing interventions that address these features. They stated that the potential to promote resilience in response to early life stressful events is promising.

The study, "Insomnia symptoms are associated with impaired resilience in bipolar disorder: Potential links with early life stressors may affect mood features and suicidal risk" was published in the Journal of Sleep Research.