Psychotherapy is a specialised branch of education and feartheseeds has hit the nail on the head by asking a question on the comments for this post about how knowledge of the link between REM sleep (the brain state in which dreaming occurs) and depression can be used to help treat and manage bipolar disorder, in which a (most likely genetic) predisposition for mania precedes and follows intensely depressive episodes in a destructive swinging pattern.
Rather than reply further in a comment, I thought I would consider this in a post by itself because it’s an interesting and valid topic that we haven’t yet addressed on this blog.
“Essentially: If I have a disease that prevents me from either wanting to get better (mania) or being able to actually seek treatment (depression), and then causes long lasting natural depressions via lack of sleep, how can I (or: can I) modify my sleeping patterns without medications specifically prescribed to do so?”
Firstly it’s important to stress that we really don’t advocate treating bipolar disorder without medication. Having said that however, we know people who have developed ways of managing their bipolar disorder without drugs. It obviously depends on the individual state of the sufferer and their access to support and resources that they can use to help them.
In order to organise what I want to say about how the human givens approach and knowledge about the importance of sleep can help someone manage bipolar disorder, I’m going to descend into bullet points:
1) Sleep and depression.
For the reasons described in Ivan’s youtube video, and detailed in this article, we now know why depressed people dream more than non depressed people. It is because dreaming evolved to dearouse the autonomic nervous system from unacted out emotions and worrying during the day produces an enormous amount of arousals that the brain has to dream about. By doing more dreaming in the REM state, which burns up energy, than having recuperative slow wave sleep, which energises the brain and mind/body system, the sleep pattern becomes distorted. This is the reason why depressed people, however much they sleep, always wake up feeling exhausted.
In addition, the orientation response, which fires continually during dreaming, is firing excessively because of the extra amount and intensity of a depressed persons dreaming, and so it gets tired out too. This is the same neuronal pathway we also need to focus and motivate ourselves to do anything during the daytime. Since it is doing things that make our lives feel meaningful, this lack of motivational energy (the orientation response drives motivation) makes life seem meaningless. This should not be underestimated, human suffering cannot get any worse that severe depression: it can even lead people to take their own life.
2) Sleep and Mania
Mania can be seen as the opposite to depression with regards to REM sleep. Someone in a manic phase sleeps less and therefore has less REM sleep to dearouse the autonomic nervous system. In depression they do too much REM sleep. Staying awake all night, intense euphoria, all the symptoms of mania, are not conducive to healthy sleeping patterns.
Just as ordinary sleep deprivation leads to hallucinations (as in the case of Peter Tripp, the radio DJ who in 1959 stayed awake for 8 days as a sponsored “wake-a-thon” stunt before the truly dangerous effects of sleep deprivation were widely known. Tripp suffered severely disturbing hallucinations and delusions and was thought to have suffered more long-term side effects.) Sleeping less through a manic phase can quickly create a severe psychotic state.
Perception distortions occur in waking life because, quite literally, the distinct difference between waking reality and dreaming reality has been blurred, the person literally is dreaming during waking to compensate for the lack of good quality dreaming at night, which we all need a certain amount of to survive…
3) Managing sleep.
So while it is generally agreed now that bipolar disorder has a genetic component, it is obvious that individual sleeping patterns (brought on by the disorder or not) do play a part in the severity of the depression and mania, and my point is, that by managing sleep patterns (and by managing I mean trying hard in a depressive phase to limit your sleep to a healthy amount, waking up at a healthy time every morning, not sleeping in when you feel tired etc, and in a manic phase, doing everything you can to get the REM sleep you need) at the very least reduce symptoms of both bipolar moods and improve your quality of life. Drugs are not the only way of regulating REM sleep, although some of them do, and this is why they work.
Doing this on your own may be hard work, so making sure you and everyone around you knows the signs of when you might be slipping into depression or rising into mania and learns how to help you manage your sleep and also meet your emotional needs (this needs a whole bullet point to itself!) will help a lot.
4) The importance of meeting essential emotional needs.
When someone with bipolar disorder starts swinging towards a depressive phase, they start over compensating for the REM sleep they have missed out of during the manic phase.
A depressive phase is a sign for themselves and people around them to look at what is causing them to worry, boost emotional support and get help to get the emotional needs met (see here for a list of essential emotional needs, or “human givens”). This is so obvious but is incredibly important and can’t be said enough times. Anything to do with not meeting an innate emotional need will trigger anxiety and a depressive episodes and more REM sleep, and bipolar people obviously have a particular sensitivity for this. People do not have mental health problems when their innate emotional needs are met so ensuring they are is the best therapy anyone could have.
Accordingly, someone swinging towards a phase of mania is (among other things) not doing enough dreaming – and everything must be done to remedy that and get enough sleep, or the manic person will reach a stage where the balance will tip, and to compensate they will fall back into REM sleep and depression again.
Meeting emotional needs also reduces arousal levels, which is crucial for arousal levels (which need to be de-aroused nightly during dreaming) in waking life.
So, if emotional needs are met and the importance of REM sleep is understood and managed, bipolar mood cycles become less intense and more manageable, as someone who has experienced years passing before a bipolar episode begins again, can affirm.
Therapists, GP’s and anyone who works, lives with, suffers from or knows someone with bipolar disorder need to be aware of, and learn to work with, this information. I see a great deficit in the knowledge of how to treat bipolar disorder and depression, and a severe lack of services in the NHS that provide this information to people who need it.
Thanks so much to feartheseeds for bringing this subject to attention on this blog.
Comments, questions, personal experience, criticisms, suggestions are welcome.
Posted by: Eleanor