A reader asked:
I have recently had the opportunity to become acquainted with a 17 year
old who has symptoms of BD. After being hospitalized for several weeks
at age 15, she was unable to finish high school. When I met her 5 months
ago, she told me that she had gotten her GED and was looking into
taking a course to become a CNA. Since that time, she has completed the
course and has been working in a nursing home nearby for approximately 4
weeks. She doesn't have a driver's license, nor does her mom, with whom
she lives. I offered to help her get her permit and eventually her
driver's license while in the meantime, helping out by driving her to
and from her job. One of the issues that I see is that, while clearly
motivated to get ahead, sleep has been a problem for her. She has a
terrible time getting ready for work and tends to sleep longer than she
should. I don't really see her in a depressed state otherwise, but she
is often tired. Any ideas on why this may be?
Dr. Dave answers:
Sleep problems are very common in bipolar disorder, even between episodes of mania and depression. Sleeping too much (hypersomnia) tends to be more common in winter months, but some people have chronic problems with waking up. I would suggest:
1. getting a sleep study. That means going into a lab and sleeping for a night while undergoing an EEG and other assessments. It is a good way to determine whether there she has sleep apnea or another sleep disorder. It usually has to be ordered by a GP.
2. If she is taking psychiatric medications, she should discuss the sleep issue with her psychiatrist- it may be that her medications (particularly antipsychotics) are causing "sleep intertia", where the person feels like there is a huge weight pressing down on them when they wake up, and they literally can't get out of bed. Sometimes that is a medication after-effect.
3. Avoid alcohol and other substances (including marijuana), especially close to bedtime.
4. There are good self-help books, like "End the Insomnia Struggle" by Colleen Ehrnstrom and Alisha Brosse, which contains lots of adaptations she can try at home (for example, adjusting the amount of light in her bedroom).
5. Some people benefit from a morning light or "dawn simulator", which essentially extends the day by providing the equivalent of sunlight early in the morning.
Good luck! Glad you're helping her.