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Insomnia and Type 2 Bipolar Disorder

Daniel Becker

Daniel Becker, M.D.

Mills-Peninsula Medical Group

Question:

I come from a long line of insomniacs who struggle to put together more than three hours of sleep at once. I've heard that chronic insomnia that runs in families can be an indicator of Type 2 Bipolar Depression. What are your thoughts?

Answer:

Bipolar II disorder is a major mood disorder characterized by a history of one or more major depressive episodes, as well as one or more hypomanic episodes. Hypomanic episodes are similar to manic episodes - consisting of grandiose or irritable mood, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased activity, and excessive involvement in (often self-destructive) pleasurable activities. The distinction between hypomania and mania is essentially one of duration (with hypomanic episodes needing to last only four days, at minimum) and severity (with hypomanic individuals showing neither psychosis nor other severe functional impairment).

Bipolar II disorder occurs relatively infrequently, affecting only approximately one-half of one percent of the population. The majority of such individuals function well between mood episodes (i.e., when they are experiencing neither a major depressive episode nor a hypomanic episode).

As indicated above, hypomania is characterized by a decreased need for sleep - although not insomnia. Major depressive episodes, on the other hand, are characterized by sleep disturbance (often in the form of insomnia). Therefore, individuals with bipolar II disorder would have a high likelihood of periodically experiencing diminished sleep. Also, bipolar II disorder runs in families, with close relatives showing elevated rates of bipolar II disorder, bipolar I disorder, and major depressive disorder. For this reason, family members of those with bipolar II disorder would be expected to have diminished sleep compared with the general population. But, while it is likely that those with bipolar II disorder have family members who sleep less than the rest of us, there is no clear evidence that a family history of chronic insomnia is a specific indicator of bipolar II disorder.

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