Lithium and valproic acid in bipolar disorder: Beyond mood stabilization, the overlooked role of sleep

Sleep is a critical yet often underestimated physiological parameter in psychiatric disorders. In their article, Gokcay et al examined sleep quality in bipolar disorder patients treated with lithium or valproic acid, showing lithium's advantage in habitual sleep efficiency and reduced disturbances. While this study provides valuable data in a chronic and clinically challenging cohort, reliance solely on self-reported sleep measures remains a limitation. Polysomnography, although the gold standard, is not always practical; therefore, actigraphy and wearable technologies represent feasible alternatives to capture objective sleep patterns. This letter emphasizes the importance of integrating objective, scalable technologies and pharmacological monitoring into longitudinal designs to clarify whether improvements in sleep translate into better clinical outcomes and reduced relapse risk in bipolar disorder.