Who is my brain?: Insomnia and Bipolar
On BlueSky, someone mentioned their difficulty with sleeping. I debated about saying anything, having long suffered well-meaning “have you tried?”s, but they’ve written about mental health issues similar to mine. I took the chance and talked about the treatments I have done. They thanked me or said “oh interesting” or something like that, and the conversation concluded.
Sometime later, this interaction replayed itself in a dream. Instead of that social media friend, I was chatting with a coworker. The coworker mentioned their sleep issues, and I repeated my list of treatments. The dream coworker asked, “Why are you telling me this? Why do you care?”
“Because you are bipolar like me, and it’s important you take care of your sleep,” I explained. “Bipolar and sleep issues are from the same source of dysregulation.” I looked at the “camera,” as I said this, as if I was looking at my dreaming self, the viewer.
Upon waking, I wondered. . .well, I wondered a lot of things. Did the coworker represent some aspect of myself? Was I talking to myself? Was it true, that bipolar and insomnia are caused by the same misfiring in the brain? Was some other entity speaking to me through me?
Who is my brain?
I’ve not done much research on bipolar since my diagnosis nearly twenty years ago. The broad strokes have been enough for me, and much of my mentally ill life has been trying different medications and lots of talk therapy. EMDR therapy in my thirties was a huge help, but even that I didn’t really research. I needed help ASAP and the therapist was nearby and available. I was lucky that she was also awesome. So. I turned to Google.
“During an episode of depression, bipolar patients experience insomnia and/or hypersomnia; one study found that 100% experienced insomnia while another reported that 78% experienced hypersomnia.
”Overall, the data suggest that sleep disturbance is a prominent feature of bipolar disorder in youth.
“In summary, the evidence suggests that pervasive sleep disturbance is characteristic of bipolar disorder.”
One of the first hits is a paper about sleep and bipolar. That sleep disturbance in youth is a potential symptom is fascinating. I had sleep issues even before my father took sick and died. Was the bipolar inevitable? Or perhaps I could have lived happily (/s) as a simple insomniac?
I’ve never noticed lack of sleep triggering mania. An uptick in nightmares and bad dreams is usually a symptom of PMS. (“Women with PMS exhibited an increase in nightmare frequency during the premenstrual phase, but no formal statistical comparisons were made between PMS and non‐PMS groups regarding dream frequency or intensity.” Nightmares Fluctuate Across the Menstrual Cycle and May be More Pronounced in Women With Premenstrual Syndrome, doi 10.1002/brb3.70383). The bad sleep, I think, has been far more consistent than the bipolar. Which, like, duh.
“The average patient with bipolar disorder (BD) spends half their life struggling with mood symptoms and the other half struggling with sleep.1,2 Insomnia persists in 70% of patients even when their mood is stable, and these sleep problems put them at risk for more episodes of mania and depression.
“Cognitive behavioral therapy for insomnia (CBT-i) is thought to work by stabilizing the circadian system, making it a natural fit for mood disorders. In unipolar depression, CBT-i improves mood and sleep, but the therapy is often avoided in BD because it requires patients to limit their time in bed, raising concerns that this sleep deprivation could trigger mania.”
“During the inter-episode period, clinically significant sleep disturbance persists in up to 70% of BD patients.
“Given the high rates of sleep disturbance in BD, it is surprising that few controlled trials of medication or psychological interventions for sleep have been conducted in this population.”
The psychiatrist and CBT-I doctor I saw both pointed out how little research there is on nightmares in general. Which is weird to me simply because humans have been fascinated by dreams since at least the fifteenth century BCE (Babylonian dream tablets). Joseph interprets Pharaoh's dream in Genesis, dating to roughly a century later. If some of the first writing, and longest lived stories, are about dreams, I suspect they were important long before written language. But there’s only so much time and money for research, I guess. Much of the current research is on veterans, and personally I’m okay with veterans getting the research funds before me.
Did I already know about these connections? They match my lived experiences. Had I heard about these connections and forgotten? Why did this show up in a dream now and why does it matter (does it)? What am I supposed to do now and next?
I have always wondered, of course, about how different my life would be if my dad didn’t die, my mom didn’t go crazy (to be indelicate), if I wasn’t diagnosed as bipolar. Is there a Multiverse Natasha with a “normal” brain? I hope she’s doing well. Further, I have assumed Dad’s death ultimately led to my bipolar. But the bad sleep predates his death. Was the bipolar inevitable?
Insomnia, PTSD, bipolar, generalized anxiety, genetics, outside stimuli. Who is my brain?
Having now had decades of therapy, I can see that I clearly had anxiety as a child. I was going to end up diagnosed with something. But I had seen the “sleep thing” as separate from the bipolar. Probably because nightmares and insomnia manifested first. WHICH IS QUITE NORMAL, APPARENTLY. But, for example, I have curly hair, and that’s not related to being bipolar, those are just two things I happen to have. These mental processes are all interconnected. Natasha never had a chance.
But what do I do with this? I can’t fix the past. I can’t take or make or try preventatives. It’s too late to myself become a scientist and study these topics. I guess I get to feel self satisfied that what I’ve always suspected is true?
Who is my brain?
