Bipolar Bozuklukta Uyku ve Sirkadiyen Ritim Bozuklukları: Klinik ve Güncel Yaklaşımlar
Özet
Bipolar affektif bozukluk (BAB), manik ve depresif epizodlarla seyreden kronik ve yineleyici bir duygudurum bozukluğudur. Uyku ve sirkadiyen ritim bozuklukları hastalığın en önemli biyolojik ve klinik özellikleri arasında yer almakta ve hem atak dönemlerinde hem de remisyon sürecinde görülebilmektedir. İnsomnia, hipersomni, gecikmiş uyku fazı ve uyku-uyanıklık döngüsündeki düzensizlikler bipolar bozuklukta sık bildirilen uyku sorunlarıdır. Bu bozukluklar yalnızca semptomlara eşlik eden ikincil durumlar değil, aynı zamanda hastalığın gidişini etkileyen ve nüks riskini artırabilen önemli klinik belirteçler olarak kabul edilmektedir. Uyku ve sirkadiyen ritimdeki bozulmalar bilişsel işlevsellik, psikososyal uyum ve yaşam kalitesi üzerinde olumsuz etkiler oluşturabilmektedir. Bu bölümde bipolar bozuklukta uyku fizyolojisi ve sirkadiyen ritim mekanizmaları ele alınmakta; manik, depresif ve remisyon dönemlerinde görülen uyku değişiklikleri güncel literatür ışığında değerlendirilmektedir. Ayrıca uyku bozukluklarının klinik sonuçları, değerlendirme yöntemleri ve tedavi yaklaşımları tartışılmakta; kronoterapi, davranışçı müdahaleler ve farmakolojik tedaviler gibi güncel klinik yaklaşımlar ele alınmaktadır.
Bipolar disorder is a chronic and recurrent mood disorder characterized by alternating manic and depressive episodes. Disturbances in sleep and circadian rhythms represent one of the key biological features of the disorder and may persist not only during acute mood episodes but also during remission. Common sleep problems reported in bipolar disorder include insomnia, hypersomnia, delayed sleep phase, and irregular sleep–wake patterns. These disturbances are increasingly recognized not merely as secondary symptoms but as clinically significant markers that may influence the course of the illness and increase the risk of relapse. Disruptions in sleep and circadian rhythms can also negatively affect cognitive functioning, psychosocial adjustment, and overall quality of life. This chapter reviews the physiology of sleep and circadian rhythm mechanisms in bipolar disorder and discusses sleep changes observed across manic, depressive, and remission phases. In addition, the clinical consequences, assessment strategies, and treatment approaches for sleep disturbances are examined. Current clinical perspectives including chronotherapy, behavioral interventions, and pharmacological treatments are discussed to provide an integrated understanding of sleep disturbances in bipolar disorder.
Referanslar
Bai C, Fan X, Lu W, et al. Meta-analysis of recurrence rate and influencing factors of bipolar disorder. Journal of Affective Disorders. 2026 Feb 1;394:120570. https://doi.org/10.1016/j.jad.2025.120570
Moya-Lacasa C, Paniagua G, Couce-Sánchez M, et al. Sleep disturbances linked to plasma orexin A levels in patients with bipolar disorder: A preliminary study. Comprehensive Psychoneuroendocrinology. 2025 Nov 1;24:100321. doi: 10.1016/j.cpnec.2025.100321
Bort M, Possidente C, Oliva V, et al. Boulevard of broken rhythms: A systematic review and meta-analysis on the relationship between sleep disturbances and suicidal behavior in bipolar disorder. European Psychiatry. 2025;68(1):e154. doi: 10.1192/j.eurpsy.2025.10102
Geoffroy PA, Palagini L, Henriksen TEG, et al. Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force. Dialogues in Clinical Neuroscience. 2025;27(1):249-264. doi: 10.1080/19585969.2025.2533806
Melo MCA, Abreu RLC, Linhares Neto VB, et al. Chronotype and circadian rhythm in bipolar disorder: A systematic review. Sleep Medicine Reviews. 2017 Aug 1;34:46–58. https://doi.org/10.1016/j.smrv.2016.06.007
Cruickshank HK, Varela RB, Truong TTT, et al. Melatonin in bipolar disorder. Journal of Affective Disorders. 2026 Apr 1;398:120871. https://doi.org/10.1016/j.jad.2025.120871
Li T, Yang T, Lin Y, et al. Case series of aripiprazole monotherapy in bipolar disorder with delayed sleep-wake phase syndrome. BMC Psychiatry. 2025 Dec 1;25(1):899. doi: 10.1186/s12888-025-07289-y
Li P, Zhu J, Zhang H, et al. The role of orexin and MCH neurons in the hypothalamus in sleep-wake regulation and learning-forgetting balance. Frontiers in Neuroscience. 2025;19:1590556. doi: 10.3389/fnins.2025.1590556
Morse AM. Enhancing the Management of Hypersomnia: Examining the Role of the Orexin System. Seminars in Neurology. 2025 May 12;45(3):410–419. DOI: 10.1055/a-2589-3825
Colita CI, Hermann DM, Filfan M, et al. Optimizing Chronotherapy in Psychiatric Care: The Impact of Circadian Rhythms on Medication Timing and Efficacy. Clocks Sleep. 2024 Dec 1;6(4):635-655. doi: 10.3390/clockssleep6040043
Chung J, Kim YC, Jeong JH. Bipolar Disorder, Circadian Rhythm and Clock Genes. Clinical Psychopharmacology and Neuroscience. 2023;22(2):211-221. doi: 10.9758/cpn.23.1093
Ulrichsen A, Mühlbauer E, Hartnagel LM, et al. Can Sleep Parameters Predict Upcoming Mood Episodes in Bipolar Disorder? Bipolar Disorders. 2025 Sep 1;27(6):449-460. doi: 10.1111/bdi.70054
Marchetti M, Mayeli A, Sanguineti C, et al. Sleep abnormalities in bipolar disorders across mood phases: A systematic review and meta-analysis. Sleep Medicine Reviews. 2025 Oct 1;83:102137. https://doi.org/10.1016/j.smrv.2025.102137
Yıldız Bayındır B, Coskun M, Karayagmurlu A. Sleep disturbances in autistic youth with and without bipolar disorder: A matched case–control study. Sleep Medicine. 2025 Mar 1;127:152–157. https://doi.org/10.1016/j.sleep.2025.01.022
Geoffroy PA, Roure R, Sebille SB, et al. A large-scale study of chronic sleep disorders in psychiatric inpatients: Prevalence, hospitalization burden, restraint use, and comorbidities. European Psychiatry. 2025 Nov 19;68(1):e169. doi: 10.1192/j.eurpsy.2025.10131
Wang M, An X, Han D, et al. The effect of systematic antidepressant treatments in the early stages on sleep and impulsivity in bipolar euthymic patients: A cross-sectional study. PLoS One. 2025 Apr 1;20(4):e0322274. doi: 10.1371/journal.pone.0322274
Ejiohuo O, Bilska K, Gattner K, et al. Association of FKBP5 gene polymorphism with insomnia symptoms in the depressive episodes of stress-related bipolar disorder. Advances in Medical Sciences. 2025 Oct 1;70(2):335–345. https://doi.org/10.1016/j.advms.2025.09.004
Pini S, Tramontano D, Nardi B, et al. Adult separation anxiety and insomnia symptoms in individuals with mood and anxiety disorders. Neuroscience Applied. 2025 Jan 1;5:106877. doi: 10.1016/j.nsa.2025.106877
Leseur J, Maruani J, Palagini L, et al. Objective sleep markers to differentiate unipolar and bipolar depression: A systematic review and meta-analysis. Neuroscience Biobehavioral Reviews. 2025 Apr 1;171:106070. https://doi.org/10.1016/j.neubiorev.2025.106070
Ulrichsen A, Tröger A, Jauhar S, et al. Do sleep variables predict mood in bipolar disorder: A systematic review. Journal of Affective Disorders. 2025 Mar 15;373:364–373. https://doi.org/10.1016/j.jad.2024.12.098
Takim U, Gokcay H, Sağlam T. Evaluation of sleep quality in patients diagnosed with bipolar disorder and major depression during remission period. World Journal of Psychiatry. 2025 Dec 19;15(12):112601. doi: 10.5498/wjp.v15.i12.112601
Oakes DJ, Pearce HA, Roberts C, et al. Associations between comorbid anxiety and sleep disturbance in people with bipolar disorder: Findings from actigraphy and subjective sleep measures. Journal of Affective Disorders. 2022 Jul 15;309:165-171. doi: 10.1016/j.jad.2022.04.065
Carpenter JS, Crouse JJ, Park SH, et al. Actigraphy-derived circadian rhythms, sleep-wake patterns, and physical activity across clinical stages and pathophysiological subgroups in young people presenting for mental health care. Journal of Psychiatric Research. 2025 Jun 1;186:396–406. https://doi.org/10.1016/j.jpsychires.2025.03.003
Fuglsang NFB, Madsen NM, Jacobsen SL, et al. Efficacy and Acceptability of Licensed and Off‐Label Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness: A Systematic Review and Meta‐Analysis of Randomised Trials. Acta Psychiatrica Scandinavica. 2025 Dec 1;152(6):405-421. doi: 10.1111/acps.70032
Gokcay H, Takım U, Sağlam T. Sleep quality in bipolar disorder: A comparative study of treatment with lithium and valproic acid. World Journal of Psychiatry. 2025 Nov 19;15(11):111807. doi: 10.5498/wjp.v15.i11.111807
Hennion V, Scott J, Martinot V, et al. Associations between actigraphy estimates of sleep and circadian rhythmicity and psychotropic medications in bipolar disorders: An exploratory study. Journal of Affective Disorders. 2024 Mar 1;348:224–228. https://doi.org/10.1016/j.jad.2023.12.075
Golebiowski R, Mansukhani MP, Kolla BP. Correlates to Improvement in Sleep Duration in Acute Mania and Depression. Primary Care Companion for CNS Disorders. 2024;26(1):23m03620. doi: 10.4088/PCC.23m03620
Fauska C, Bastiampillai T, Adams RJ, et al. Effects of the antipsychotic quetiapine on sleep and breathing: a review of clinical findings and potential mechanisms. Journal of Sleep Research. 2024 May 1;33(3):e14051. doi: 10.1111/jsr.14051
Dallaspezia S, Benedetti F. Chronobiologic treatments for mood disorders. Handbook of Clinical Neurology. 2025 Jan 1;206:181–192. https://doi.org/10.1016/B978-0-323-90918-1.00011-3
Garyfalli V, Kalisperakis E, Smrynis A, et al. Smartwatch-Derived Digital Phenotypes Relate to Psychopathology Dimensions in Patients With Psychotic Spectrum Disorders: Longitudinal Observational Study. JMIR Mental Health. 2025 Dec 12;12:e75774. doi: 10.2196/75774
Fellendorf FT, Hamm C, Dalkner N, et al. Monitoring Sleep Changes via a Smartphone App in Bipolar Disorder: Practical Issues and Validation of a Potential Diagnostic Tool. Frontiers in Psychiatry. 2021 Mar 24;12:641241. doi: 10.3389/fpsyt.2021.641241
Morton E, Nicholas J, Yang L, et al. Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management. International Journal of Bipolar Disorders. 2022 Dec 1;10(1):10. doi: 10.1186/s40345-022-00256-6
Cho CH, Lee T, Kim MG, et al. Mood Prediction of Patients With Mood Disorders by Machine Learning Using Passive Digital Phenotypes Based on the Circadian Rhythm: Prospective Observational Cohort Study. Journal of Medical Internet Research. 2019 Apr 1;21(4):e11029. doi: 10.2196/11029
Kragh M, Dyrberg H, Kristiansen ST, et al. Efficacy of a Transdiagnostic Sleep and Circadian Intervention for Outpatients With Sleep Problems and Depression, Attention Deficit Disorder, or Bipolar Disorder: A Randomised Controlled Trial. Journal of Sleep Research. 2025;e70088. https://doi.org/10.1111/jsr.70088
Dyrberg H, Kristiansen ST, Speed M, et al. A transdiagnostic sleep intervention for outpatients with sleep problems and comorbid mental health disorders, data from a Danish quality assurance project. Nordic Journal of Psychiatry. 2025 Nov 17;79(8):623–631. https://doi.org/10.1080/08039488.2025.2571217
Tonon AC, Nexha A, Mendonça da Silva M, et al. Sleep and circadian disruption in bipolar disorders: From psychopathology to digital phenotyping in clinical practice. Psychiatry and Clinical Neurosciences. 2024 Nov 1;78(11):654-666. doi: 10.1111/pcn.13729
Goldschmied JR, Palermo E, Yocum Aet al. The relationship between sleep and circadian patterns with risk for suicide in bipolar disorder varies by subtype. Journal of Psychiatric Research. 2024 Jan 1;181:23-28. doi:10.1016/j.jpsychires.2024.11.030
Referanslar
Bai C, Fan X, Lu W, et al. Meta-analysis of recurrence rate and influencing factors of bipolar disorder. Journal of Affective Disorders. 2026 Feb 1;394:120570. https://doi.org/10.1016/j.jad.2025.120570
Moya-Lacasa C, Paniagua G, Couce-Sánchez M, et al. Sleep disturbances linked to plasma orexin A levels in patients with bipolar disorder: A preliminary study. Comprehensive Psychoneuroendocrinology. 2025 Nov 1;24:100321. doi: 10.1016/j.cpnec.2025.100321
Bort M, Possidente C, Oliva V, et al. Boulevard of broken rhythms: A systematic review and meta-analysis on the relationship between sleep disturbances and suicidal behavior in bipolar disorder. European Psychiatry. 2025;68(1):e154. doi: 10.1192/j.eurpsy.2025.10102
Geoffroy PA, Palagini L, Henriksen TEG, et al. Light therapy for bipolar disorders: Clinical recommendations from the international society for bipolar disorders (ISBD) Chronobiology and Chronotherapy Task Force. Dialogues in Clinical Neuroscience. 2025;27(1):249-264. doi: 10.1080/19585969.2025.2533806
Melo MCA, Abreu RLC, Linhares Neto VB, et al. Chronotype and circadian rhythm in bipolar disorder: A systematic review. Sleep Medicine Reviews. 2017 Aug 1;34:46–58. https://doi.org/10.1016/j.smrv.2016.06.007
Cruickshank HK, Varela RB, Truong TTT, et al. Melatonin in bipolar disorder. Journal of Affective Disorders. 2026 Apr 1;398:120871. https://doi.org/10.1016/j.jad.2025.120871
Li T, Yang T, Lin Y, et al. Case series of aripiprazole monotherapy in bipolar disorder with delayed sleep-wake phase syndrome. BMC Psychiatry. 2025 Dec 1;25(1):899. doi: 10.1186/s12888-025-07289-y
Li P, Zhu J, Zhang H, et al. The role of orexin and MCH neurons in the hypothalamus in sleep-wake regulation and learning-forgetting balance. Frontiers in Neuroscience. 2025;19:1590556. doi: 10.3389/fnins.2025.1590556
Morse AM. Enhancing the Management of Hypersomnia: Examining the Role of the Orexin System. Seminars in Neurology. 2025 May 12;45(3):410–419. DOI: 10.1055/a-2589-3825
Colita CI, Hermann DM, Filfan M, et al. Optimizing Chronotherapy in Psychiatric Care: The Impact of Circadian Rhythms on Medication Timing and Efficacy. Clocks Sleep. 2024 Dec 1;6(4):635-655. doi: 10.3390/clockssleep6040043
Chung J, Kim YC, Jeong JH. Bipolar Disorder, Circadian Rhythm and Clock Genes. Clinical Psychopharmacology and Neuroscience. 2023;22(2):211-221. doi: 10.9758/cpn.23.1093
Ulrichsen A, Mühlbauer E, Hartnagel LM, et al. Can Sleep Parameters Predict Upcoming Mood Episodes in Bipolar Disorder? Bipolar Disorders. 2025 Sep 1;27(6):449-460. doi: 10.1111/bdi.70054
Marchetti M, Mayeli A, Sanguineti C, et al. Sleep abnormalities in bipolar disorders across mood phases: A systematic review and meta-analysis. Sleep Medicine Reviews. 2025 Oct 1;83:102137. https://doi.org/10.1016/j.smrv.2025.102137
Yıldız Bayındır B, Coskun M, Karayagmurlu A. Sleep disturbances in autistic youth with and without bipolar disorder: A matched case–control study. Sleep Medicine. 2025 Mar 1;127:152–157. https://doi.org/10.1016/j.sleep.2025.01.022
Geoffroy PA, Roure R, Sebille SB, et al. A large-scale study of chronic sleep disorders in psychiatric inpatients: Prevalence, hospitalization burden, restraint use, and comorbidities. European Psychiatry. 2025 Nov 19;68(1):e169. doi: 10.1192/j.eurpsy.2025.10131
Wang M, An X, Han D, et al. The effect of systematic antidepressant treatments in the early stages on sleep and impulsivity in bipolar euthymic patients: A cross-sectional study. PLoS One. 2025 Apr 1;20(4):e0322274. doi: 10.1371/journal.pone.0322274
Ejiohuo O, Bilska K, Gattner K, et al. Association of FKBP5 gene polymorphism with insomnia symptoms in the depressive episodes of stress-related bipolar disorder. Advances in Medical Sciences. 2025 Oct 1;70(2):335–345. https://doi.org/10.1016/j.advms.2025.09.004
Pini S, Tramontano D, Nardi B, et al. Adult separation anxiety and insomnia symptoms in individuals with mood and anxiety disorders. Neuroscience Applied. 2025 Jan 1;5:106877. doi: 10.1016/j.nsa.2025.106877
Leseur J, Maruani J, Palagini L, et al. Objective sleep markers to differentiate unipolar and bipolar depression: A systematic review and meta-analysis. Neuroscience Biobehavioral Reviews. 2025 Apr 1;171:106070. https://doi.org/10.1016/j.neubiorev.2025.106070
Ulrichsen A, Tröger A, Jauhar S, et al. Do sleep variables predict mood in bipolar disorder: A systematic review. Journal of Affective Disorders. 2025 Mar 15;373:364–373. https://doi.org/10.1016/j.jad.2024.12.098
Takim U, Gokcay H, Sağlam T. Evaluation of sleep quality in patients diagnosed with bipolar disorder and major depression during remission period. World Journal of Psychiatry. 2025 Dec 19;15(12):112601. doi: 10.5498/wjp.v15.i12.112601
Oakes DJ, Pearce HA, Roberts C, et al. Associations between comorbid anxiety and sleep disturbance in people with bipolar disorder: Findings from actigraphy and subjective sleep measures. Journal of Affective Disorders. 2022 Jul 15;309:165-171. doi: 10.1016/j.jad.2022.04.065
Carpenter JS, Crouse JJ, Park SH, et al. Actigraphy-derived circadian rhythms, sleep-wake patterns, and physical activity across clinical stages and pathophysiological subgroups in young people presenting for mental health care. Journal of Psychiatric Research. 2025 Jun 1;186:396–406. https://doi.org/10.1016/j.jpsychires.2025.03.003
Fuglsang NFB, Madsen NM, Jacobsen SL, et al. Efficacy and Acceptability of Licensed and Off‐Label Pharmacological Interventions for Insomnia in Patients With Severe Mental Illness: A Systematic Review and Meta‐Analysis of Randomised Trials. Acta Psychiatrica Scandinavica. 2025 Dec 1;152(6):405-421. doi: 10.1111/acps.70032
Gokcay H, Takım U, Sağlam T. Sleep quality in bipolar disorder: A comparative study of treatment with lithium and valproic acid. World Journal of Psychiatry. 2025 Nov 19;15(11):111807. doi: 10.5498/wjp.v15.i11.111807
Hennion V, Scott J, Martinot V, et al. Associations between actigraphy estimates of sleep and circadian rhythmicity and psychotropic medications in bipolar disorders: An exploratory study. Journal of Affective Disorders. 2024 Mar 1;348:224–228. https://doi.org/10.1016/j.jad.2023.12.075
Golebiowski R, Mansukhani MP, Kolla BP. Correlates to Improvement in Sleep Duration in Acute Mania and Depression. Primary Care Companion for CNS Disorders. 2024;26(1):23m03620. doi: 10.4088/PCC.23m03620
Fauska C, Bastiampillai T, Adams RJ, et al. Effects of the antipsychotic quetiapine on sleep and breathing: a review of clinical findings and potential mechanisms. Journal of Sleep Research. 2024 May 1;33(3):e14051. doi: 10.1111/jsr.14051
Dallaspezia S, Benedetti F. Chronobiologic treatments for mood disorders. Handbook of Clinical Neurology. 2025 Jan 1;206:181–192. https://doi.org/10.1016/B978-0-323-90918-1.00011-3
Garyfalli V, Kalisperakis E, Smrynis A, et al. Smartwatch-Derived Digital Phenotypes Relate to Psychopathology Dimensions in Patients With Psychotic Spectrum Disorders: Longitudinal Observational Study. JMIR Mental Health. 2025 Dec 12;12:e75774. doi: 10.2196/75774
Fellendorf FT, Hamm C, Dalkner N, et al. Monitoring Sleep Changes via a Smartphone App in Bipolar Disorder: Practical Issues and Validation of a Potential Diagnostic Tool. Frontiers in Psychiatry. 2021 Mar 24;12:641241. doi: 10.3389/fpsyt.2021.641241
Morton E, Nicholas J, Yang L, et al. Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management. International Journal of Bipolar Disorders. 2022 Dec 1;10(1):10. doi: 10.1186/s40345-022-00256-6
Cho CH, Lee T, Kim MG, et al. Mood Prediction of Patients With Mood Disorders by Machine Learning Using Passive Digital Phenotypes Based on the Circadian Rhythm: Prospective Observational Cohort Study. Journal of Medical Internet Research. 2019 Apr 1;21(4):e11029. doi: 10.2196/11029
Kragh M, Dyrberg H, Kristiansen ST, et al. Efficacy of a Transdiagnostic Sleep and Circadian Intervention for Outpatients With Sleep Problems and Depression, Attention Deficit Disorder, or Bipolar Disorder: A Randomised Controlled Trial. Journal of Sleep Research. 2025;e70088. https://doi.org/10.1111/jsr.70088
Dyrberg H, Kristiansen ST, Speed M, et al. A transdiagnostic sleep intervention for outpatients with sleep problems and comorbid mental health disorders, data from a Danish quality assurance project. Nordic Journal of Psychiatry. 2025 Nov 17;79(8):623–631. https://doi.org/10.1080/08039488.2025.2571217
Tonon AC, Nexha A, Mendonça da Silva M, et al. Sleep and circadian disruption in bipolar disorders: From psychopathology to digital phenotyping in clinical practice. Psychiatry and Clinical Neurosciences. 2024 Nov 1;78(11):654-666. doi: 10.1111/pcn.13729
Goldschmied JR, Palermo E, Yocum Aet al. The relationship between sleep and circadian patterns with risk for suicide in bipolar disorder varies by subtype. Journal of Psychiatric Research. 2024 Jan 1;181:23-28. doi:10.1016/j.jpsychires.2024.11.030
