Comparison of sleep/wake parameters for self-monitoring bipolar disorder

Background: Psychosocial interventions may teach patients with bipolar disorder to successfully detect warning signs of relapse. These interventions often include ongoing self-monitoring of sleep. We previously reported that a change in sleep duration (sleep plus bedrest) of >3 h may indicate that a mood change is imminent. This analysis further investigated whether sleep duration, sleep onset or sleep offset was the Most useful sleep/wake parameter to monitor for an oncoming mood change. Methods: 101 adult outpatients receiving treatment as usual recorded mood, sleep and medications every day on a home computer for a mean of 265 +/- 103 days. A daily time series of mood, sleep duration (sleep plus bedrest), sleep onset and sleep offset was constructed for each patient. After applying an ARIMA (0,1,1) filter, a cross correlation function was used to analyze the temporal relationship between the residuals for lags of +/- 7 days. Results: Less frequent significant correlations were found between a change in either sleep onset or sleep offset and mood, than between sleep duration and mood. Patients with a significant correlation between sleep duration and mood included 86% of those with a significant correlation between sleep onset or sleep offset and mood. Mean sleep duration when euthymic was long (>= 8 h in 89% of patients, >= 9 h in 51% of patients). Limitations: Self-reported data, naturalistic study, and computer access required. Conclusions: Self-monitoring of sleep duration is recommended for patients with bipolar disorder. Better understanding of the long sleep duration of euthymic patients is required. (C) 2008 Elsevier B.V. All rights reserved.