[How to characterize and treat sleep complaints in bipolar disorders?]
OBJECTIVE
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.
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: pierrealexis.geoffroy@aphp.fr.
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Geoffroy
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.
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Micoulaud Franchi
Centre national de référence narcolepsie et hypersomnie idiopathique, CHU Gui-De-Chauliac, 34000 Montpellier, France; U1061, Inserm, 34000 Montpellier, France.
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Lopez
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.
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Poirot
Réseau Morphée, 92380 Garches, France.
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Brion
Réseau Morphée, 92380 Garches, France; Clinique du Château, 92380 Garches, France.
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Royant-Parola
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.
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Etain
D001714:Bipolar Disorder / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D002940:Circadian Rhythm; D006801:Humans; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*
Bipolar disorders; Circadian rhythms; Hypersomnia; Hypersomnie; Insomnia; Insomnie; Rythmes circadiens; Sleep; Sommeil; Trouble bipolaire