Rapid resolution of first episodes of mania: sleep related?

While sleep deprivation has been observed to precipitate mania, the relationship between sleep and resolution of mania is less well understood. We observed a rapid reversal of manic symptoms in several patients hospitalized for mania who slept many hours on Night 1 of hospitalization. We therefore undertook to study this relationship more systematically.

Charts for all patients admitted with a diagnosis of bipolar disorder, manic within a 2-year period were retrospectively reviewed. Patients were assigned to a group called "rapid responders" if improvement in symptoms, as described in progress notes, was moderate by Day 2 of hospitalization. Patients were "nonrapid responders" if improvement in symptoms was minimal or mild by Day 2. Sleep records, medications, and demographic data were obtained by researchers blind to the patients' response status on Day 2 of hospitalization.

Compared with the 27 patients who did not have a rapid response, the 7 rapid responders were significantly more likely to (1) be in a first manic episode, (2) have a stressor associated with the onset of mania, (3) sleep more hours the first night of hospitalization, and (4) spend fewer days in the hospital.

The possibility is raised that sleep restoration might induce a rapid antimanic response in patients experiencing their first episode of mania. The clinical implications of a rapid reversal of mania--including a reduction in number of hospital days--are discussed.