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Treatment in Psychiatry   |    
Behavioral Treatment of Insomnia in Bipolar Disorder
Katherine A. Kaplan, M.A.; Allison G. Harvey, Ph.D.
Am J Psychiatry 2013;170:716-720. doi:10.1176/appi.ajp.2013.12050708
View Author and Article Information

The authors report no financial relationships with commercial interests.

Supported by NIMH grant R34 MH080958 (to Dr. Harvey) and a National Science Foundation Graduate Research Fellowship Grant (to Ms. Kaplan).

From the Department of Psychology, University of California, Berkeley.

Address correspondence to Dr. Harvey (aharvey@berkeley.edu).

Copyright © 2013 by the American Psychiatric Association

Received May 29, 2012; Revised February 13, 2013; Accepted February 19, 2013.

Abstract

Sleep disturbance is common in bipolar disorder. Stimulus control and sleep restriction are powerful, clinically useful behavioral interventions for insomnia, typically delivered as part of cognitive-behavioral therapy for insomnia (CBT-I). Both involve short-term sleep deprivation. The potential for manic or hypomanic symptoms to emerge after sleep deprivation in bipolar disorder raises questions about the appropriateness of these methods for treating insomnia. In a series of patients with bipolar disorder who underwent behavioral treatment for insomnia, the authors found that regularizing bedtimes and rise times was often sufficient to bring about improvements in sleep. Two patients in a total group of 15 patients reported mild increases in hypomanic symptoms the week following instruction on stimulus control. Total sleep time did not change for these individuals. Two of five patients who underwent sleep restriction reported mild hypomania that was unrelated to weekly sleep duration. Sleep restriction and stimulus control appear to be safe and efficacious procedures for treating insomnia in patients with bipolar disorder. Practitioners should encourage regularity in bedtimes and rise times as a first step in treatment, and carefully monitor changes in mood and daytime sleepiness throughout the intervention.

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