Q. I recently read an article from Medline that purports regulation of body rhythms (i.e. sleep, eating, exercise) as important for controlling bipolar disease. Sleep disruption especially has the ability to dysregulate the neurotransmitters in the brain and possibly trigger a bipolar episode. I had read in an earlier article that loss of sleep can actually trigger a manic episode.

My question: Would biorhythm regulation prevent a genetic predisposition to bipolar disease from expressing itself?

My son is very erratic and dysregulated without stable sleep, eating or exercising patterns. It is possible he carries the genes for bipolar disorder, as although I have not sought treatment, I believe I suffer from it. My father has the established disorder, having been hospitalized for it, as have 4 of my siblings. His mother, and my maternal grandmother both had the disorder, as well as aunts and uncles on both sides of my family. My sister's son, 17, the same age as my son, is currently being treated for bipolar, having just recently been released from his hospital confinement.

My son is closed to the idea that he may carry the genes, and that they may express themselves later, because he is afraid of the social stigma. (My husband's family does not seem to carry this trait). My son, however, is very much like me, and does not seem to resemble my husband's traits very much compared to mine. I'd appreciate advice for my son, as soon he will be going to college, and will have full control of regulating his behaviors. Currently, what regulation he has comes from me.

 

  A. The question around biorhythms is an interesting one. I agree with all your views concerning the ability of lack of sleep to dysregulate bipolars. There are studies out that show correcting sleep patterns can help with bipolar disorder, but it is a chicken versus egg type argument. Are they manic because they failed to regulate their sleep patterns, or were sleep patterns disrupted because mania was coming on? I do not know. Purely from a pragmatic standpoint, there is nothing to lose by carefully controlling sleep, meals, exercise, etc.

In much the same way a diabetic controls when they eat and how much they eat to better control their illness, it makes perfect sense to do everything possible to avert a manic episode. Depressive episode frequency seems to go up with sleep disruption, too. Unlike diabetes where dietary control is of utmost importance, we are not sure if controlling sleep matters in bipolar disorder. Late adolescents want to be independent, and do what their friends are doing. Going to college usually is associated with late nights for most because of studying and partying/socializing. It will be a difficult time for your son and he may feel he'll stand out in a bad way if he has to go to bed by 11 PM. Hopefully, he can see the bigger picture and give it a try.