Vivid Dreams, Nightmares, and Night Terrors in Bipolar Disorder

Disturbed sleep is common in people who have bipolar disorder. Many experience nightmares and even night terrors, coupled with either insomnia or too much sleep, depending on whether they're experiencing a manic or depressive episode.

Woman with bipolar disorder waking up from a nightmare
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Vivid Dreams and Nightmares

Nightmares are disturbing, well-remembered dreams that usually incite anxiety and fear. They typically occur later in the evening during rapid eye movement (REM) sleep and cause a person to wake up abruptly.

Some experts believe that nightmares in people with bipolar disorder may predict upcoming mood shifts. For example, according to an article in Mental Health Reviews, people heading into a manic episode tended to dream more about death and injury. On the other hand, those moving into a depressive episode had dreams with more anxiety-related themes.

Nightmares in Children

Children who have bipolar disorder also suffer disproportionately from nightmares. Dreams of explicit violence, gore, and death are common experiences, as are dreams that signal a fear of abandonment. Of course, most children experience nightmares on occasion. Children with bipolar disorder, however, can experience nightmares that last hours.

Night Terrors

Night terrors are also common in people with bipolar disorder. Unlike nightmares, night terrors do not occur during REM sleep, although they have some nightmarish elements. They occur instead either during deep sleep or in a transitional state between deep and dreaming sleep.

A night terror isn't a dream, but rather an abrupt awakening accompanied by physical symptoms like feelings of intense fear, screaming or thrashing, and elevated heart rate and blood pressure, among others. During a night terror, the person awakes in a state of terror and is typically confused and inconsolable. They may or may not recall the episode in the morning.

Night terrors are rare in adults, yet many who experience them have mood-related mental health conditions, such as bipolar disorder, depression, and anxiety. Examples of night terrors reported in adults with bipolar disorder include walls closing in on them or insects or reptiles crawling over their bedroom. In these episodes, people may abruptly sit up in bed, sometimes screaming or thrashing around in fear. They seem confused and don't recognize anyone; some even run from the bedroom in an apparent attempt to avoid harm.

Lamictal and Dream Abnormalities

Lamictal (lamotrigine) is a mood stabilizer approved by the Food and Drug Administration (FDA) to treat bipolar disorder and certain seizure disorders. It effectively prevents the recurrence/relapse of mood episodes in both bipolar I and bipolar II. Almost two-thirds of people who have bipolar mood disorders have responded extremely well to adjunctive Lamictal therapy.

However, some people who take Lamictal can experience a variety of sleep-related side effects, including abnormal dreams. Two long-term studies found that 6% of adults who used Lamictal monotherapy experienced abnormal dreams (in the form of vivid dreams and nightmares). This adverse effect usually improved by lowering the dosage and taking the medication in the morning.

If you think Lamictal is causing abnormal dreams, talk to your doctor. Remember that it's never a good idea to stop taking a medication cold turkey or change the dose of a medication without first consulting your healthcare provider.

Coping

Researchers don't know much about what causes people with bipolar disorder to experience nightmares and night terrors. What is known is that the continuation of these sleep disturbances increases the severity and frequency of symptoms during both manic and depressive episodes.

Getting a good night's sleep is essential to living a manageable life with bipolar disorder. If you're struggling with sleep disturbances such as nightmares or night terrors, experts recommend you do the following:

  • Establish a bedtime routine. Stick to a set of habits that help prepare you for rest each night. Take a bath, read a book, or listen to some music to calm your body and help set the mood for a sound night's sleep. Creating a routine can give your mind something to focus on instead of your worries and anxiety.
  • Avoid substances that interfere with sleep. Some substances like caffeine prevent you from sleeping, while others such as alcohol or marijuana can help you fall asleep, but can affect the quality of your sleep. Avoid all for a more restful sleep.
  • Exercise regularly. Exercise helps maintain good health. But if it's done late at night, it can significantly interfere with your ability to fall and stay asleep, especially if you're living with bipolar disorder. Exercising in the earlier part of the day, on the other hand, can help support healthy sleep.
  • Talk to your doctor. If you're concerned about the frequency of your nightmares or night terrors, schedule an appointment to see your doctor. You might also want to ask your doctor whether any of the medications you're taking (both over-the-counter and prescription) cause sleep problems as a side effect, and whether an alternative option may be more suitable.

A Word From Verywell

Adequate sleep is essential for both mental and physical health, and research suggests that poor sleep can contribute to relapses in bipolar disorder. Therefore, if you're troubled by vivid dreams, be sure to talk to your doctor about it. Some medications may be able to suppress your dreams so you can get a more peaceful night's sleep.

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  1. Pancheri C, Verdolini N, Pacchiarotti I, et al. A systematic review on sleep alterations anticipating the onset of bipolar disorder. Eur Psychiatry. 2019;58:45-53. doi:10.1016/j.eurpsy.2019.02.003

  2. Ameen, S, Ranjan, S, Nizamie, S. The reinterpretation of dreams. Mental Health Reviews. 2002.

  3. Baroni A, Hernandez M, Grant MC, Faedda GL. Sleep disturbances in pediatric bipolar disorder: A comparison between bipolar I and bipolar NOS. Front Psychiatry. 2012;3:22. doi:10.3389/fpsyt.2012.00022

  4. Ohayon MM, Guilleminault C, Priest RG. Night terrors, sleepwalking, and confusional arousals in the general population: Their frequency and relationship to other sleep and mental disorders. J Clin Psychiatry. 1999;60(4):268-76. doi:10.4088/jcp.v60n0413

  5. Chang JS, Moon E, Cha B, Ha K. Adjunctive lamotrigine therapy for patients with bipolar II depression partially responsive to mood stabilizers. Prog Neuropsychopharmacol Biol Psychiatry. 2010;34(7):1322-1326. doi:10.1016/j.pnpbp.2010.07.020

  6. Lamictal. Prescribing information. GlaxoSmithKline; 2009.

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