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Bipolar Disorder and Narcolepsy: Understanding the Connection

Posted on November 18, 2021
Medically reviewed by
Allen J. Blaivas, D.O.
Article written by
Imee Williams

Narcolepsy increases the risk of many mental health conditions, such as depression, schizophrenia, eating disorders, anxiety, and attention deficit hyperaction disorder (ADHD). Sleep impairments are a distinctive feature of bipolar disorder, a mental illness that causes extreme mood swings and shifts in energy levels. Excessive daytime sleepiness and insomnia are common symptoms of narcolepsy. Over the past decade, scientists have explored the connection between narcolepsy and bipolar disorder.

This article will explain how bipolar disorder and narcolepsy are related: their prevalence, causes, and shared risk factors. It will also discuss how to manage both conditions so that you can feel your best and improve your overall quality of life.

What Is Bipolar Disorder?

Bipolar disorder — also known as manic depression — is a mental disorder often seen in early adulthood (ages 18 to 29). However, bipolar disorder can develop during adolescence or middle adulthood as well. About 2.8 percent of adults have bipolar disorder in the United States.

Symptoms

People with bipolar disorder experience manic episodes and depressive episodes that can last days to months.

Manic episode symptoms include:

  • High energy
  • Feeling very happy or irritable
  • Sleep deprivation (insomnia)
  • Loss of appetite
  • Increased or faster speech
  • Racing thoughts
  • Increased risky behavior
  • Difficulty focusing
  • Hallucinations or delusions, in severe cases

Depressive episode symptoms include:

  • Low energy
  • Decreased sleep, daytime sleepiness, or excessive sleep (hypersomnia)
  • Loss of interest in favorite activities
  • Restlessness
  • Intense sadness or despair
  • Feelings of guilt or worthlessness
  • Difficulty concentrating
  • Increased or decreased appetite
  • Suicidal thoughts

The exact cause of bipolar disorder is not well understood. However, researchers believe it results from a combination of genetics, environmental factors, and changes in the structure and chemistry of the brain. In addition, the age of onset, gender, and duration of illness dramatically influences the development of bipolar disorder.

Known risk factors of bipolar disorder include:

  • Having a family history of mental health or mood disorders
  • Structural and chemical brain abnormalities
  • Traumatic or stressful life events
  • Heavy drinking or excessive use of drugs
  • Sleep disorders or irregular sleeping patterns

How Is Narcolepsy Related to Bipolar Disorder?

Narcolepsy and mental health disorders often occur alongside another. In fact, narcolepsy is commonly misdiagnosed as a mental health disorder. It is unknown how common bipolar disorder is among those with narcolepsy due to limited research. However, numerous studies have found a connection between narcolepsy and bipolar disorder.

Brain Chemistry

Researchers are still uncertain about the root cause of bipolar disorder in people living with narcolepsy. Some theories suggest that narcolepsy is caused by abnormal brain functioning, similar to depression and other mental health conditions.

Hypocretins (orexins) are neurotransmitters that help regulate sleep, appetite, and arousal. Studies have found that reduced levels of hypocretins are associated with narcolepsy with cataplexy. Other studies looked at hypocretin levels in major depressive disorder (MDD) and bipolar disorder, but had conflicting results. A 2019 study found low levels of hypocretins in people with bipolar disorder, while a 2021 study observed high levels of hypocretins in people with MDD and bipolar disorder. More research needs to be done to understand the relationship between hypocretins and bipolar disorder.

Treatment of Narcolepsy

Narcolepsy is typically treated with psychostimulants and antidepressants to help with fatigue and daytime sleepiness. However, some medications can potentially trigger manic symptoms, especially in those at high risk for bipolar disorder.

One case report found that modafinil and venlafaxine may induce manic symptoms in people with narcolepsy with cataplexy. It is important to note that these treatments do not cause bipolar disorder, but they may increase the risk if you have underlying bipolar symptoms. People at a higher risk for bipolar disorder should talk with their neurologist about treatment options or be potentially screened for bipolar disorder by a mental health specialist.

Co-Occurring Sleep Disorders

Sleep disturbances harm an individual’s overall quality of life. A 2019 study found that sleep disturbances are a characteristic of bipolar disorder and can be used as an indicator to diagnose this condition early.

During manic or depressive episodes, people can experience insomnia (lack of sleep) and hypersomnia (excess sleeping or daytime sleepiness). One study found that 100 percent of individuals with bipolar disorder going through a depressive episode experienced insomnia. Another study reported that between 69 percent to 99 percent of individuals who go through a manic episode experience insomnia. A third study found that about 78 percent of individuals going through a depressive episode experienced hypersomnia.

Stress

There are many stressors in life. However, those living with narcolepsy may experience more significant amounts of stress compared to the general population. The symptoms, course of the disease, and unknown cause or cure can place tremendous stress on a person. Narcolepsy symptoms impact a person’s ability to do daily tasks and activities, as well as their personal and work relationships.

Stress also plays a role in the development of bipolar disorder. Those who experience traumatic events such as an illness, a death in the family, divorce, difficult or unstable relationships, or financial problems can experience a manic or depressive episode.

Living With Narcolepsy and Bipolar Disorder

Treatment for narcolepsy and bipolar disorder is usually lifelong and often involves a combination of medications and therapy. “I have narcolepsy with cataplexy and bipolar depression,” shared a MyNarcolepsyTeam member. “I’m on several medications and sleep with a BiPAP. With all this, I’ve been able to work full-time and live a normal life.”

It is essential to take medications as prescribed and to continue with therapy to manage symptoms. Read more about treatments for narcolepsy and bipolar disorder.

Therapy

Therapy can help people manage stress and their bipolar symptoms, improve personal relationships, and cope in a healthy way with trauma or stress. Studies have shown that people with bipolar disorder who take medications and attend therapy recover more quickly from their depressive episodes. Several types of therapy are available today. Discuss options with your health care provider to decide which one best fits your needs.

Lifestyle Changes

Lifestyle changes can help you manage narcolepsy and bipolar symptoms. These include:

  • Reducing stress
  • Avoiding alcohol and drugs
  • Maintaining a sleep schedule
  • Scheduling naps, work, and activities
  • Eating a healthy diet
  • Exercising regularly
  • Seeking support from your friends, family, or community

Talk With Others Who Understand

MyNarcolepsyTeam is the social network for people with narcolepsy and their loved ones. On MyNarcolepsyTeam, more than 7,600 members come together to ask questions, give advice, and share their stories with others who understand life with narcolepsy.

Do you have narcolepsy? Have you also been diagnosed with bipolar disorder? Share your experience in the comments below, or start a conversation by posting on MyNarcolepsyTeam.

All updates must be accompanied by text or a picture.
Allen J. Blaivas, D.O. is certified by the American Board of Internal Medicine in Critical Care Medicine, Pulmonary Disease, and Sleep Medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Imee Williams is a freelance writer and Fulbright scholar, with a B.S. in neuroscience from Washington State University. Learn more about her here.

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