Abstract
Background
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.
Methods
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.
Results
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.
Conclusions
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.
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.
Methods
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.
Results
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.
Conclusions
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.
| Original language | English |
|---|---|
| Pages (from-to) | 3345 - 3354 |
| Number of pages | 10 |
| Journal | Psychological Medicine |
| Volume | 53 |
| Issue number | 8 |
| Early online date | 25 Jan 2022 |
| DOIs | |
| Publication status | Published - 1 Jun 2023 |
Bibliographical note
Funding Information:This work was supported by: Health and Care Research Wales, the Wellcome Trust (Welcome Trust Institutional Strategic Support Fund Consolidator Award and grant 220488/Z/20/Z awarded to KJSL) and the UK Medical Research Council (MRC) (grant MR/N027485/1, awarded to KT and funding JH). The Bipolar Disorder Research Network is funded by a Wellcome Trust strategic award (102616/Z). True Colours and KEAS received support from the National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre. This research was funded in whole, or in part, by the Wellcome Trust (220488/Z/20/Z). For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press.
Keywords
- bipolar disorder
- sleep
- insomnia
- mania
- depression
- intensive longitudinal data
- autoregressive effect
- dynamic structural equation modelling
- DSEM
- Mplus