Comparison of sleep/wake parameters for self-monitoring bipolar disorder

UMMS Affiliation

Department of Psychiatry

Publication Date


Document Type



Adult; Bipolar Disorder; Drug Therapy; Female; Humans; Male; Mood Disorders; Recurrence; *Self Efficacy; Sleep Disorders, Circadian Rhythm; Young Adult


Mental and Social Health | Psychiatry | Psychiatry and Psychology


BACKGROUND: Psychosocial interventions may teach patients with bipolar disorder to successfully detect warning signs of relapse. These interventions often include ongoing self-monitoring of sleep. We previously reported that a change in sleep duration (sleep plus bedrest) of >3 h may indicate that a mood change is imminent. This analysis further investigated whether sleep duration, sleep onset or sleep offset was the most useful sleep/wake parameter to monitor for an oncoming mood change.

METHODS: 101 adult outpatients receiving treatment as usual recorded mood, sleep and medications every day on a home computer for a mean of 265+/-103 days. A daily time series of mood, sleep duration (sleep plus bedrest), sleep onset and sleep offset was constructed for each patient. After applying an ARIMA (0,1,1) filter, a cross correlation function was used to analyze the temporal relationship between the residuals for lags of +/-7 days.

RESULTS: Less frequent significant correlations were found between a change in either sleep onset or sleep offset and mood, than between sleep duration and mood. Patients with a significant correlation between sleep duration and mood included 86% of those with a significant correlation between sleep onset or sleep offset and mood. Mean sleep duration when euthymic was long (> or =8 h in 89% of patients, > or =9 h in 51% of patients).

LIMITATIONS: Self-reported data, naturalistic study, and computer access required.

CONCLUSIONS: Self-monitoring of sleep duration is recommended for patients with bipolar disorder. Better understanding of the long sleep duration of euthymic patients is required.

DOI of Published Version



J Affect Disord. 2009 Aug;116(3):170-5. doi: 10.1016/j.jad.2008.11.014. Link to article on publisher's site

Journal/Book/Conference Title

Journal of affective disorders

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Link to Article in PubMed

PubMed ID