Q:  Alpha Intrusion & Bipolar Disorder

Dr. Phelps,

My daughter was diagnosed with bipolar, last Sept.  She is 26, and I suspect she had it as a child.  Therefore, she and we, her family, have had many years of hell not knowing what she had, nor what to do for her.

Dr. this is serious, she does not sleep well.  She didn't finish high school, nor can she work.  Since she can't go to sleep nor wake up well enough to function normally.  She's not suicidal now, but she tells me that if she can't reach her goals, there's no point in living.  I can't blame her but I don't want to loose her.

She's been diagnosed too with a sleep disorder, called Alpha Intrusion.  So when she finally gets to sleep she doesn't easily get enough of the deep sleep that the rest of us do.

What can be done?  Does she have to take Ambien for the rest of her life?  She develops a tolerance to it and then has to up the dose.  Is there hope  that she can 'learn' to sleep better?  It is driving me crazy to watch her be so stuck and not be able to attain the goals she has for her life.  It is heartbreakingly hard.

Where do we go and what can we do?  This is painful and awful.  Thank you for your time and attention to this matter and for your timely response.

Sincerely,
Rosella


Dear Rosella  -- 
I'm not aware of any research "alpha intrusion" and it's relationship to bipolar disorder (e.g. is it a separate condition? or is this something that might get better with more direct management of sleep the same way we do with bipolar disorder, especially the manic phase which often includes this kind of decreased total sleep)

Literature searching (using PUB MED; e.g. searching alpha intrusion bipolar [no results] or alpha sleep bipolar [results below]) yielded quite a few articles on alpha intrusion and fibromyalgia, but none specifically relating alpha intrusion and bipolar disorder.  The closest comments were these: 

In the last 30 years, it has been convincingly demonstrated that sleep in major depression is characterized by disturbances of sleep continuity, a reduction of slow wave sleep, a disinhibition of REM sleep including a shortening of REM latency (i.e. the time between sleep onset and the occurrence of the first REM period) and an increase in REM density. Furthermore, manipulations of the sleep-wake cycle like total or partial sleep deprivation or phase advance of the sleep period have been proven to be effective therapeutic strategies for patients with unipolar depression. The database concerning sleep and sleep-wake manipulations in bipolar disorder in comparison is not yet as extensive. Studies investigating sleep in bipolar depression suggest that during the depressed phase sleep shows the same stigmata as in unipolar depression. During the hypomanic or manic phase, sleep is even more curtailed, though subjectively not experienced as disturbing by the patients. REM sleep disinhibition is present as well. An important issue is the question, whether sleep-wake manipulations can also be applied in patients with bipolar depression. Work by others and our own studies indicate that sleep deprivation and a phase advance of the sleep period can be used to treat bipolar patients during the depressed phase. The risk of a switch into hypomania or mania does not seem to be more pronounced than the risk with typical pharmacological antidepressant treatment. For patients with mania, sleep deprivation is not an adequate treatment--in contrast, treatment strategies aiming at stabilizing a regular sleep-wake schedule are indicated. Reimann

and a Japanese article from 1994 (that's a long time ago; yet using the PUB MED feature to search for "related articles", little more recent shows up): : 

The literature dealing with electroencephalogram (EEG) in manic-depressive psychosis is reviewed. It is concluded that although there are no specific EEG patterns in the psychosis, some reports suggest a predominance of the alpha activity and a heightened arousal response. From many studies on sleep and depression, it appears that the EEG sleep architecture in depression is characterized by reduced total sleep time, intermittent awakenings, decreased slow-wave sleep and shortened REM latency. In particular, shortened REM latency is important for diagnosis of primary depression. Furthermore, the meaning of abnormal EEGs reported in the psychosis is worth investigating. In order to make the pathophysiology of manic-depressive psychosis clearer, it is important to carry out a comprehensive research, including clinical, physiological, biochemical and molecular biological study.

The point: there is not a lot of research I can find to help clarify whether this alpha pattern is part of her bipolar problem, or a separate one. If it's separate, I'm sorry, I have no expertise with that. You might try searching around the fibromyalgia literature on this problem, to see what you can learn (e.g. go to that PUB MED link above, which will help you learn how to search if you're not handy with that, and search alpha intrusion fibromyalgia, which will yield quite a bit of stuff to look over; a local hospital librarian can also help both with the search and with interpreting the results, although a sleep specialist would be best at that). . 

If there is truly a connection to the bipolar disorder (and that actually seems likely -- how unlucky to have two odd conditions; more likely to have two odd manifestations of a single condition?), then the goal would be to fully manage any other signs or symptoms of mania and hope that in so doing, the sleep problem gets better.  I hope there's some room to pursue that approach, because that leaves you "on the map", the standard map of how to treat bipolar mania (here are some guides you can look at: see the links from the first few paragraphs on my mood stabilizers page). 

Dr. Phelps

 

Published September, 2005