TREATMENT OF A RAPIDLY CYCLING BIPOLAR PATIENT BY USING EXTENDED BED REST AND DARKNESS TO STABILIZE THE TIMING AND DURATION OF SLEEP

Background: The modern practice of using artificial light to extend wa king activities into the nighttime hours might be expected to precipit ate or exacerbate bipolar illness, because it has been shown that modi fying the timing and duration of sleep can induce mania in susceptible individuals. With this possibility in mind, we treated a patient with rapidly cycling bipolar illness by creating an environment that was l ikely to increase and to stabilize the number of hours that he slept e ach night. Methods: We asked the patient to remain at bed rest in the dark for 14 hours each night (later this was gradually reduced to 10 h ours). Over a period of several years, his clinical state was assessed with twice-daily self-ratings, once-weekly observer ratings, and cont inuous wrist motor activity recordings. Times of sleeping and waking w ere recorded with sleep logs, polygraphic recordings, and computer-bas ed event recordings. Results: The patient cycled rapidly between depre ssion and mania and experienced marked fluctuations in the timing and duration of sleep when he slept according to his usual routine, but hi s sleep and mood stabilized when he adhered to a regimen of long night ly periods of enforced bed rest in the dark. Conclusions: Fostering sl eep and stabilizing its timing by scheduling regular nightly periods o f enforced bed rest in the dark may help to prevent mania and rapid cy cling in bipolar patients. Published 1998 Society of Biological Psychi atry.