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. 2025 Sep;27(6):449-460.
doi: 10.1111/bdi.70054. Epub 2025 Aug 22.

Can Sleep Parameters Predict Upcoming Mood Episodes in Bipolar Disorder?

Andrea Ulrichsen  1   2 , Esther Mühlbauer  1 , Lisa-Marie Hartnagel  3 , Emanuel Severus  1 , Anthony Cleare  2 , Sameer Jauhar  2 , Michael Bauer  1 , Ulrich Ebner-Priemer  3   4   5
Affiliations

Can Sleep Parameters Predict Upcoming Mood Episodes in Bipolar Disorder?

Andrea Ulrichsen et al. Bipolar Disord. 2025 Sep.

Abstract

Background: Bipolar disorder (BD) is a recurrent disorder, characterised by episodes of (hypo)mania, depression and euthymia with variation in mood, cognition and sleep. Many patients identify changes in sleep before an episode; using daily sleep logs could help identify these changes. Such early warning signs can be a valuable tool for patients and clinicians alike in predicting and preparing for changes in mood.

Methods: In the BipoSense study, we followed patients with BD, who were in remission at the start of the study, daily for 1 year. Patients reported for each hour if they were awake or asleep through an app and received fortnightly clinical assessments of bipolar symptoms. We used statistical analyses applying person-centred data in multilevel logit models to investigate if sleep patterns could differentiate between the period before an episode (prodromal stage) and euthymia, looking at both mean changes and variability of sleep. Bonferroni-Holm corrections were applied to avoid inflation of type I errors from multiple testing.

Results: Twenty-nine participants were included (mean age 44.0 years [SD = 11.9], female 55% and BD-I 59%). Waking up later was associated with prodromal depression and was the only significant finding for prodromal mood episodes. Greater variability of sleep duration, total time spent in bed and time waking up were associated with prodromal depression; less variability of time falling asleep and time waking up were linked with prodromal (hypo)mania.

Conclusion: Using self-assessed sleep changes and especially variability can be potential tools in helping patients identify early warning signs of mood recurrence; however, these analyses were explorative and further investigations are warranted.

Keywords: bipolar disorder; depression; early warning signs; mania; mood prediction; sleep.

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Figures

FIGURE 1
FIGURE 1
Episode phase as the analysis outcomes. Hypomania and mania are combined into one mood category, (hypo)mania. Euthymia status is defined as any timepoint not otherwise specified as an episode phase. DE = depressive episode, ME = (hypo)manic episode.
FIGURE 2
FIGURE 2
(A) Sleep patterns across depressive episode phase. (B) Sleep patterns across (hypo)manic episode phase. (C) Sleep patterns across mood episodes. (A–C) Time in bed (asleep or awake) differences for depressive Episode phase (A), (hypo)manic episode phase (B), and all mood episodes (C). The graphs show the various hours (h) of the day patients on average were either awake or asleep (0 = awake, 1 = asleep).
See this image and copyright information in PMC

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