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In the last section, we discussed conditions that may co-occur
disorder. These conditions are autoimmune disorders, borderline personality
cyclothymic disorder. We also presented ways to diagnose these comorbid
conditions along with ways to treat clients with comorbid conditions.
One of the core problems in bipolar disorder as you know is instability. Without
sort of stability, a bipolar client’s body chemistry becomes confused.
In this section, we will present the traits of the sleep-wake cycle and how it
affects bipolar clients: social Zeitstorers, social Zeitgebers, and a
regulated sleep pattern.
3 Traits of the Sleep-Wake Cycle
♦ 1. Social Zeitstorers
According to researcher Cindy Ehlers, the first trait of the sleep-wake is a
social Zeitstorer. A social Zeitstorer is a person or social demand that
throws a person’s sleeping patterns off balance. For example, a
Zeitstorer may be a new relationship which alters the client’s patterns
sleeping and waking.
A job that requires extensive travel can also be a
social Zeitstorer. A social Zeitstorer can have significant debilitating
effects on a bipolar client’s circadian rhythm, or the more biologically
driven cycles such as when a client falls asleep, when he or she wakes up,
or his or her pattern of rapid-eye movement during sleep. When these
circadian rhythms are interrupted, a bipolar client is much more vulnerable
to falling into a manic or depressive episode.
Lisa, a 36-year-old bipolar II client, lived with her husband Gerry. During
a therapy session with the couple, Lisa complained that Gerry had changed
the schedule for feeding their two cats. He had begun to feed them both
the morning instead of the evening, and as a result one or both of the cats
were coming into the couple’s room in the middle of the night crying for
food. Lisa wanted to feed the cats before she and Gerry went to bed, but
refused, saying it would make the cats overweight.
After three consecutive
nights of poor sleep, Lisa became irritable, experienced mental confusion at
work, and developed racing thoughts. Finally, Gerry agreed to the new
evening feeding schedule, which alleviated the problem with the cats. As
Lisa returned to a regular sleep-wake cycle and experienced several nights
of restorative sleep, her hypomania started to recede. As you can see,
cats’ feeding schedule had become a social Zeitstorer, which interrupted
Lisa’s circadian rhythm and almost sent her into full fledged mania. The
return to normalcy
is what I like to call, "substituting a social Zeitgeber."
♦ 2. Social Zeitgebers
A social Zeitgeber, the second trait of the sleep-wake cycle, is quite the
opposite of a social Zeitstorer. Social Zeitgebers are people or events
that function as an external time clock to regulate a client’s habits. A
spouse or even a dog that needs to be regularly walked can be considered a social Zeitgeber. Social Zeitgebers affect sleeping and eating habits in
stable manner, keeping the balance of everyday activities.
A bipolar client
with several stable social Zeitgebers will be less likely to slip into a
manic or depressive episode because their sleep patterns are regulated.
Shawn, age 26 and a bipolar II client, had just been reassigned to a
position in his company that required him to travel all over the world to
attend business meetings. Although Shawn was ecstatic about the opportunity
to travel, it soon became apparent that the inevitable jet lag he underwent
interrupted his circadian. Shawn slipped into a manic episode, sleeping
about three to four hours a night for near to a month.
Very quickly, Shawn
began to show visible
signs of extreme fatigue and was admitted to a hospital in London for
exhaustion. Due to the danger that the new position posed for his health,
Shawn opted for a job that remained in one city, which he was fortunately
granted. For those bipolar clients suffering from social Zeitstorers, like
Lisa and Shawn, I recommend stabilizing their schedules or, "substituting
social Zeitgeber". For Lisa, the Zeitgeber was feeding the cats
in the evening while Shawn’s Zeitgeber was a position on the ground and in the
♦ 3. Regulated Sleep Patterns - 7 Tips for a Good Night's Rest
In addition to social Zeitstorers and Zeitgebers, a third trait of the
sleep-wake cycle is a regular sleep pattern. Although this may sound
simple, for those with bipolar disorder, it is essential to avoiding a manic
or depressive episode. To do this, I give all my bipolar clients a list
of "Tips for a Good Night’s Rest" and ask them to follow it
also recommend formulating these habits to try to get about 10 hours of
sleep a night:
1. Establish a regular bedtime and stick to it as much as possible. Avoid
naps, but if you find it necessary, limit them to about twenty minutes as
continuous sleep is much more restful.
2. If you use caffeine, limit your consumption to early in the day. If
smoke or drink alcohol, stop doing so within a few hours of bedtime.
3. Let yourself unwind an hour or so before bedtime. Read a book or
magazine, listen to music, meditate, play with a pet, or take a bubble bath.
Avoid violent TV shows, and skip upsetting news reports.
4. Save the bedroom for sleeping and sex. Although light reading may be
okay, don’t bring work to bed. And save discussions for another place
time. This includes conversations about sexual problems. If you begin
associate work or arguments with your bed, it will cause more anxiety than
it is worth.
5. Don’t try to force yourself to sleep. Just enjoy resting and feeling
your muscles. Or use a relaxation technique, such as the ones found on
sections 3 and 4. Some people find listening to tapes or peaceful sounds
6. Adjust your sleep in advance when traveling to a different time zone.
For very short trips, this may not be necessary, but for longer ones, adjust
your sleep, meals, and medication dosage time to match the target time zone
over several days.
7. Block out annoying distractions. If light noise keeps you awake and
can’t block them out in other ways, cover your eyes with a black sleeping
mask and wear ear plugs.
By following these simple guidelines, bipolar clients can more easily get a
restful night’s sleep.
In this section, we discussed the traits of the sleep-wake cycle and how it
affects bipolar clients: social Zeitstorers, social Zeitgebers, and a
regulated sleep pattern
In the next section, we will examine the differences found between men and
women with bipolar disorder. We will examine differences in suicide rate,
effect of PMS on
bipolar and unipolar women, and mania in men.
Peer-Reviewed Journal Article References:
Brand, S., Gerber, M., Pühse, U., & Holsboer-Trachsler, E. (2010). Depression, hypomania, and dysfunctional sleep-related cognitions as mediators between stress and insomnia: The best advice is not always found on the pillow! International Journal of Stress Management, 17(2), 114–134.
Johnson, S. L., Tharp, J. A., Peckham, A. D., & McMaster, K. J. (2016). Emotion in bipolar I disorder: Implications for functional and symptom outcomes. Journal of Abnormal Psychology, 125(1), 40–52.
Schwartz, L. A., & Feeny, N. C. (2007). The nature of and behavioral treatment of sleep problems in youth with bipolar disorder. International Journal of Behavioral Consultation and Therapy, 3(1), 88–95.
What are three characteristics of the sleep-wake cycle? To select and enter your answer go to .