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In the last post, we saw how:
There are other specifiers that are used for characterising mood disorders like Rapid Cycling, Seasonality, and Post Partum onset.
BAD and BPD are both psychiatric disorders but BAD is a mood disorder while BPD is a personality disorder.
Carbamazepine is used for the treatment of Acute mania just like lithium and valproate.
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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for two consecutive months. This month will be dedicated to BAD or Bipolar Affective Disorder. In the first month, we discussed Depression, and in the subsequent month, anxiety. We are done looking at Twitter Posts and now we are moving to Tik Tok posts.
Announcement!!!
We are moving to our new account after this month's topic. Follow us here 
In this post, we are looking at this tweet that talks about Sleep and BAD. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
Patients who are bipolar have these major depressive episodes and manic episodes. Mood disorders are also called affective disorders 2 months ago, we talked about depression, among the types of depression is Major Depressive Disorder which is otherwise known as unipolar depression.
Specifiers
Non-DSM-5 Types
There are other systems of classifying patients that are not based on the Diagnostic and Statistical Manual. These systems separate mood disorders based on prognosis and response to therapy. Conditions may also be separated based on their reactions.
Based on this reaction depression can be classified as either biological (endogenous) or reactive )physiological). This classification is based on the availability of stress. Endogenous depression also includes the presence of diurnal variations, delusions, and other features that make it very similar to DSM’s major depression. Endogenous depression can have psychotic features or features of melancholy or the two co-existing. Reactive symptoms can include sleep problems, feelings of anxiety and physical symptoms. Many see this as a very controversial classification method.
Mood disorders in this method of classification are seen as primary depression except for when the mood disorders are secondary to a medical cause or substance that is in excess. Double depression is also described here as major depression and dysthymia happening together in a patient.
Bipolar Disorder and Sleep
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Whenever sleep changes last up to 2 weeks it usually is a sign that something is wrong. I want to talk about sleep changes in BAD because I didn't get any information about all that the tik toker posted in any blog.
Patients who have BAD can have insomnia where they don’t get enough sleep and hypersomnia where they sleep for longer hours than normal.
There might also be a feeling of reduced sleep need where they are not getting enough sleep but they feel well-rested. Patients can also complain of delayed sleep. These patients will sleep during the day and stay awake all night.
They can have abnormal dreams when their REM sleep becomes dysfunctional.
When a patient who has BAD also abuses drugs they tend to also have these sleep problems. Sleep apnea can also affect those with BAD (about a third of them).
During the highs of bipolar disorder (periods of mania), you may be so aroused that you can go for days without sleep without feeling tired the next day. For three out of four people with bipolar disorder, sleep problems are the most common signal that a period of mania is about to occur.
Sleep problems affect 3/4 of those who are about to have a manic episode in BAD. A typical precursor to BAD is when they go on for days without sleeping.
For some patients, their sleep problems are triggered by jet lag or being sleep-deprived.
Those with sleep problems can take a different presentation from the normal population. For example, when they start having these sleep problems, they may fall sick easily, have difficulty concentrating, be sluggish, tilt towards a depressive episode or have other symptoms because of the stress of not sleeping.
Discussing how these things happen is an important part of treating it/ It is important to talk to a psychiatrist so that a treatment plan can be made. A treatment plan will typically include keeping information about sleep. The information will be:
- How quickly you can go to sleep?
- How many times do you have to wake up during a night's sleep?
- How many hours can you stay asleep?
- When do you use drugs or caffeine or alcohol?
- When do you work out and for how many minutes?
The reason why it is important to get this information is that some drugs used in BAD can make BAD sleep problems worse. These drugs can be shifted to earlier hours of the day to ensure that the patient gets enough sleep. Bright light therapy of phototherapy has also been very helpful. This is done during the morning hours of the day. It is also important to avoid TV lights or light from other screens till close to bedtime. Other medical conditions that might be the cause of discomfort or pain should also be addressed.
Sleep might come back after therapy. There are also good results when caffeine pr alcohol are cut off. Another issue that needs to be addressed is a patient's partner who and pt has some other distracting behaviour while sleeping. Avoiding exercise during hate hours too can see good results.
Tips for treatment
Clonazepam and Lorazepam are very effective benzodiazepines that are used to handle mania in the acute phase. They are used in addition to other medications to manage acute episodes as well as manage sleep problems. Because these drugs are safe, they are seen as ideal when compared to lithium, valproate and carbamazepine.
Hive Stories
Read this post here
Questions
- What did you learn about mood disorders?
- What did you learn about Bipolar disorder?
- What did you learn about Bipolar disorder and sleep?
Conclusion
There are non-conventional, non-DSM classifications of Bipolar Affective Disorder.
Sleep problems do occur in the different phases of BAD.
Clonazepam can be seen as an ideal acute antimanic
I hope that you learned a lot from this post.
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References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
- Page demarcations made with Inkscape.org
- Medical News Today