How to characterize and treat sleep complaints in bipolar disorders? | Comment caractériser et traiter les plaintes de sommeil dans les troubles bipolaires ?

P.A. Geoffroy, J.-A. Micoulaud Franchi, R. Lopez, I. Poirot, A. Brion, S. Royant-Parola, B. Etain
L'Encéphale. 2017-08-01; 43(4): 363-373
DOI: 10.1016/j.encep.2016.06.007

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1. Encephale. 2017 Aug;43(4):363-373. doi: 10.1016/j.encep.2016.06.007. Epub 2016
Sep 23.

[How to characterize and treat sleep complaints in bipolar disorders?]

[Article in French]

Geoffroy PA(1), Micoulaud Franchi JA(2), Lopez R(3), Poirot I(4), Brion A(5),
Royant-Parola S(6), Etain B(7).

Author information:
(1)U1144, case 15, faculté de pharmacie, Inserm, 4, avenue de l’Observatoire,
75006 Paris, France; UMR-S 1144, université Paris Descartes, 75006 Paris, France;
UMR-S 1144, université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France;
GH Saint-Louis-Lariboisière-F.-Widal, pôle de psychiatrie et de médecine
addictologique, AP-HP, 75475 Paris cedex 10, France; Fondation FondaMental, 94000
Créteil, France. Electronic address: .
(2)USR CNRS 3413 SANPSY, université de Bordeaux, CHU Pellegrin, 33076 Bordeaux,
France; Service d’explorations fonctionnelles du système nerveux, clinique du
sommeil, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
(3)Centre national de référence narcolepsie et hypersomnie idiopathique, CHU
Gui-De-Chauliac, 34000 Montpellier, France; U1061, Inserm, 34000 Montpellier,
France.
(4)Pôle de psychiatrie, médecine légale et médecine en milieu pénitencière, unité
de sommeil de psychiatrie adulte, hôpital Fontan 1, CHRU de Lille, 59037 Lille,
France.
(5)Réseau Morphée, 92380 Garches, France.
(6)Réseau Morphée, 92380 Garches, France; Clinique du Château, 92380 Garches,
France.
(7)U1144, case 15, faculté de pharmacie, Inserm, 4, avenue de l’Observatoire,
75006 Paris, France; UMR-S 1144, université Paris Descartes, 75006 Paris, France;
UMR-S 1144, université Paris Diderot, Sorbonne Paris Cité, 75013 Paris, France;
GH Saint-Louis-Lariboisière-F.-Widal, pôle de psychiatrie et de médecine
addictologique, AP-HP, 75475 Paris cedex 10, France; Fondation FondaMental, 94000
Créteil, France.

OBJECTIVES: Sleep complaints are very common in bipolar disorders (BD) both
during acute phases (manic and depressive episodes) and remission (about 80 % of
patients with remitted BD have poor sleep quality). Sleep complaints during
remission are of particular importance since they are associated with more mood
relapses and worse outcomes. In this context, this review discusses the
characterization and treatment of sleep complaints in BD.
METHODS: We examined the international scientific literature in June 2016 and
performed a literature search with PubMed electronic database using the following
headings: « bipolar disorder » and (« sleep » or « insomnia » or « hypersomnia » or
« circadian » or « apnoea » or « apnea » or « restless legs »).
RESULTS: Patients with BD suffer from sleep and circadian rhythm abnormalities
during major depressive episodes (insomnia or hypersomnia, nightmares, nocturnal
and/or early awakenings, non-restorative sleep) and manic episodes (insomnia,
decreased need for sleep without fatigue), but also some of these abnormalities
may persist during remission. These remission phases are characterized by a
reduced quality and quantity of sleep, with a longer sleep duration, increased
sleep latency, a lengthening of the wake time after sleep onset (WASO), a
decrease of sleep efficiency, and greater variability in sleep/wake rhythms.
Patients also present frequent sleep comorbidities: chronic insomnia, sleepiness,
sleep phase delay syndrome, obstructive sleep apnea/hypopnea syndrome (OSAHS),
and restless legs syndrome (RLS). These disorders are insufficiently diagnosed
and treated whereas they are associated with mood relapses, treatment resistance,
affect cognitive global functioning, reduce the quality of life, and contribute
to weight gain or metabolic syndrome. Sleep and circadian rhythm abnormalities
have been also associated with suicidal behaviors. Therefore, a clinical
exploration with characterization of these abnormalities and disorders is
essential. This exploration should be helped by questionnaires and documented on
sleep diaries or even actimetric objective measures. Explorations such as
ventilatory polygraphy, polysomnography or a more comprehensive assessment in a
sleep laboratory may be required to complete the diagnostic assessment.
Treatments obviously depend on the cause identified through assessment
procedures. Treatment of chronic insomnia is primarily based on non-drug
techniques (by restructuring behavior and sleep patterns), on psychotherapy
(cognitive behavioral therapy for insomnia [CBT-I]; relaxation; interpersonal and
social rhythm therapy [IPSRT]; etc.), and if necessary with hypnotics during less
than four weeks. Specific treatments are needed in phase delay syndrome, OSAHS,
or other more rare sleep disorders.
CONCLUSIONS: BD are defined by several sleep and circadian rhythm abnormalities
during all phases of the disorder. These abnormalities and disorders, especially
during remitted phases, should be characterized and diagnosed to reduce mood
relapses, treatment resistance and improve BD outcomes.

Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights
reserved.

DOI: 10.1016/j.encep.2016.06.007
PMID: 27669996 [Indexed for MEDLINE]

Auteurs Bordeaux Neurocampus