Abstract
Sleep disturbances are important symptoms to monitor in people with bipolar disorder (BD) but the precise longitudinal relationships between sleep and mood remain unclear. We aimed to examine associations between stable and dynamic aspects of sleep and mood in people with BD, and assess individual differences in the strength of these associations. Participants (N = 649) with BD-I (N = 400) and BD-II (N = 249) provided weekly self-reports of insomnia, depression and (hypo)mania symptoms using the True Colours online monitoring tool for 21 months. Dynamic structural equation models were used to examine the interplay between weekly reports of insomnia and mood. The effects of clinical and demographic characteristics on associations were also assessed. Increased variability in insomnia symptoms was associated with increased mood variability. In the sample as a whole, we found strong evidence of bidirectional relationships between insomnia and depressive symptoms but only weak support for bidirectional relationships between insomnia and (hypo)manic symptoms. We found substantial variability between participants in the strength of prospective associations between insomnia and mood, which depended on age, gender, bipolar subtype, and a history of rapid cycling. Our results highlight the importance of monitoring sleep in people with BD. However, researchers and clinicians investigating the association between sleep and mood should consider subgroup differences in this relationship. Advances in digital technology mean that intensive longitudinal data on sleep and mood are becoming increasingly available. Novel methods to analyse these data present an exciting opportunity for furthering our understanding of BD.
Highlights
Sleep disturbance is increasingly recognised as important to monitor and treat in people with bipolar disorder (BD)
BD-II is more common in women, women and older participants had lower individual meanmania scores
We found evidence of subgroup differences for age and bipolar subtype – an effect of insomnia on subsequent depression was observed among younger participants, and there was evidence of a greater effect of depression on subsequent insomnia for those with BD-II
Summary
Sleep disturbance is increasingly recognised as important to monitor and treat in people with bipolar disorder (BD). Study inclusion criteria are variable, some including only participants with BD-I (Perlman et al, 2006) or those with a history of rapid cycling (Leibenluft et al, 1996) Participant characteristics such as bipolar subtype (Bauer et al, 2006; Lewis et al, 2017), gender (Lewis et al, 2017; Saunders, Fernandez-Mendoza, Kamali, Assari, & McInnis, 2015) and age (Schwarz et al, 2019) could influence the relationship between sleep and mood, and the findings from a given study. Novel methods to analyse these data present an exciting opportunity for furthering our understanding of BD
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