Bipolar blogger Natasha Tracy offers exclusive insight into the world of bipolar disorder.See all posts »
Sleep Medication in Bipolar Disorder
As I have said many times before, many professionals consider bipolar disorder to be a circadian rhythm disorder. (Your circadian rhythm is your natural body rhythm including when you sleep and wake.)
We see this manifested when people with bipolar disorder do not naturally share the same timing as others. Whereas your average person’s timing generally consists around the timing of the sun (asleep at night and awake during the day) this often isn’t the case for people with bipolar disorder. People with bipolar disorder can find themselves unable to sleep until 4 a.m. or waking up at 4 a.m. every morning.
For some people, this simply may be part of their bipolar disorder. (It’s also worth noting that sometimes this type of problem occurs as a side effect from a medication; antidepressants can often worsen sleep.)
And having an upset sleep cycle isn’t reasonable in our society as one must do things like attend school, take care of kids, work, etc., all during the day. All during the hours one should be awake.
So to facilitate this type of schedule, sleep medication is often used and in a lot of patients, and it’s used every night.
Sleep Medications Used in Bipolar Disorder
There are many options to help sleep in bipolar disorder and some are more common than others. One technique is to use drugs that have excessive sleepiness as a side effect to induce sleep. Of course, the other common technique is to prescribe medications specifically for sleep.
Some common examples of sleep medication in bipolar disorder include:
- Trazodone: trazodone (Desyrel) is a triazolopyridine derivative that belongs to the class of serotonin receptor antagonists and reuptake inhibitor antidepressants. This makes it pretty unique. It’s commonly prescribed to people with depression at bedtime to help with sleep. In fact, while I know of this drug being commonly prescribed for sleep problems, I almost never hear of if prescribed strictly as an antidepressant (but that’s me).
- Other antidepressants: other antidepressants that may have sleep-aiding properties include doxepin (Sinequan), mirtazapine (Remeron), trimipramine (Surmontil), and agomelatine. These medications appear to improve sleep not through sedative action, per se, but rather through an attempt to resynchronize the circadian rhythm.
- Antipsychotics: many antipsychotics can make a person feel extremely tired and sluggish and so many are prescribed at bedtime. The one most commonly prescribed for sleep problems proper seems to be quetiapine (Seroquel) and some people find that even small doses of that drug can help improve sleep.
- Benzodiazepines: benzodiazepines (commonly known as “benzos” or tranquilizers) are sometime prescribed for sleep, often on an as-needed basis for those that do not experience sleep problems continuously. (Benzodiazepines are also commonly prescribed for anxiety.) The two most commonly prescribed are lorazepam (Ativan) and alprazolam (Xanax). The downside with these medications is that they are known for a need to increase dose over time (tolerance) and have a notable potential for abuse.
- Nonbenzodiazepines: nonbenzodiazepines are actually very similar to benzodiazepines psychopharmacologically but have less chance for abuse. These are medications designed as sleeping pills. Tolerance to these medications can be built up over time too and rebound insomnia is often seen for a short period when they are stopped if they have been used for a significant period of time. Common nonbenzodiazepines include eszopiclone (Lunesta) and zaleplon (Sonata).
Risks and Benefits of Sleep Medication in Bipolar Disorder
The benefits are obvious: you get to sleep, feel better in the morning, and are generally more productive.
The risks are individual to the medication (make sure to discuss them with your doctor) but it is important to realize that the risk of abuse with benzodiazepines is real and should be taken seriously. No medication, especially sleep medication, should ever be used in ways for which it was not prescribed. The last thing you need is drug abuse to worry about on top of your bipolar disorder. (And let’s not forget, people with bipolar disorder have very high rates of substance use disorders.)
This is not to say that these drugs cannot be used safely. They can. I do it and so do lots of others. But know yourself: if you have had problems with drug or alcohol abuse in the past then an antidepressant or antipsychotic medication is likely a much better choice for your sleep aid.
And one last note: people often hate adding another medication to their regimen and I get that. No one particularly wants to admit that they need a medication to sleep. I get that too. But the thing is, lack of sleep is so incredibly bad for your bipolar disorder that one more pill is a tiny price to pay for stability. So talk to your doctor and find the best option for you. There’s no reason why you should have to suffer with poor quality sleep.
(Note: there are also behavioral changes that can drastically help your sleep too. Check out what I’ve written on that here.)
Recent Blog Posts
Dec 18, 2013
The End of Bipolar Bites
Dec 11, 2013
Does Having Bipolar Increase Your Risk of Dementia?
Dec 04, 2013
Why SAMHSA Should Have Nothing to Do with the Alternatives Conference