Anxieties stoke bipolar unrest.

Insomnia and other sleep problems frequently afflict people with bipolar disorder, even when they're taking medications that quell their extreme emotional highs and lows, a new study suggests. Fear and anxiety that sleep loss will trigger bouts of mania or depression--the cardinal features of bipolar disorder--wreak havoc on slumber among these individuals, say psychologist Allison G. Harvey of the University of California, Berkeley and her colleagues.

The researchers compared interview and questionnaire responses of 20 adults with bipolar disorder, 20 people with insomnia, and 20 good sleepers. All 60 volunteers also kept sleep diaries for 8 consecutive days. During that time, small devices worn on the wrist monitored each person's physical motion at night.

Fourteen of the participants with bipolar disorder reported significant sleep problems, Harvey's group reports in the January American Journal of Psychiatry. Of that number, 11 qualified for a diagnosis of insomnia. Even though the bipolar volunteers were taking medications to keep their symptoms at bay, they expressed concerns that their bouts of mania and depression would return.

In their interviews and on the questionnaires, the volunteers with bipolar disorder cited failures to establish a bedtime routine and to clear their minds of intrusive thoughts when trying to sleep. They also overestimated how long it took them to fall asleep by about 40 minutes and underestimated their total sleep time by more than 1 hour. The people with insomnia had similar misperceptions, the but good sleepers didn't.

The scientists plan to investigate whether psychotherapy that teaches bipolar patients how to alter their angst-ridden beliefs about sleep yields better slumber and fewer relapses.