Managing Sleep in Bipolar Disorder: An Overview of Pharmacological and Non-Pharmacological Interventions
Abstract
Objectives: Sleep disturbances are common in individuals with bipolar disorder (BD) and are linked to greater symptom severity, higher relapse risk, and increased suicidality. Despite their clinical relevance, sleep problems in BD are frequently underdiagnosed and inadequately treated. This systematic review aimed to evaluate the efficacy and safety of pharmacological and non-pharmacological interventions specifically targeting sleep disturbances in BD.
Methods: We systematically searched PubMed, Embase, Web of Science, and PsycINFO for studies published until May 2025. Inclusion criteria encompassed randomized controlled trials and observational studies assessing interventions specifically targeting sleep disturbances in individuals with BD.
Results: Eleven studies met the inclusion criteria. Non-pharmacological interventions, particularly cognitive behavioral therapy for insomnia adapted for bipolar disorder (CBTI-BD), consistently improved sleep efficiency, latency, and total sleep time and were associated with reductions in depressive symptoms. Bright light therapy yielded mixed results, whereas the Benson Relaxation Technique showed improvements in sleep quality and emotional regulation. Among pharmacological approaches, melatonin improved circadian alignment and sleep parameters without mood destabilization. Suvorexant showed limited efficacy. Antidepressants were linked to poorer sleep quality and greater impulsivity during euthymia.
Conclusions: Sleep-focused…
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Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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