Problems with the Mainspring: Arousal, Circadian Rhythms, and Sleep

Patient Expert

Is it bipolar, or is it something else?

With bipolar, it's not so much as what is wrong with me - it is what is wrong with the world. It is out of phase, out of sync, too fast, too slow, too clear, too blurry, 9 AM when it should be 3 AM, 11 PM and 7 AM simultaneously, days that have 26 hours in them, others with three, days of the week out of order, jet lag without flying, flying without wings, crashes, near-misses, stalled in traffic, hanging on for dear life. I should have five watches strapped to each arm, each watch going at different speeds (one running backwards), just to keep track.

Maybe our moods - our ups and downs - are simply a downstream effect of our basic settings being off. Put 3 AM where it's supposed to be, for instance, in its right order every day of the week, find out where Wednesday is supposed to go, and maybe - just maybe - the world will right itself and start to make sense.

Believe it or not, the NIMH is on the case. Well, not this case exactly. As you know from previous posts, the NIMH is undertaking a thinking-outside-the-box approach to mental illness. Part of this includes "arousal and regulatory systems," which it divides into three constructs: Arousal, circadian rhythms, and sleep and wakefulness.


According to the NIMH, arousal "facilitates interaction with the environment" and can be evoked by internal or external stimuli. There seem to be as many drives (eg hunger, sex, fear, stress) as there are different systems (including hypocretin, noradrenergic, serotonergic, histaminergic, cholinergic, and glutamatergic). It used to be thought that arousal was a simple limbic system response. Current thinking is that we are talking about diffuse but interrelated pathways. But do those pathways converge into a final pathway? That would make it a lot easier to adjust the volume. Don't count on it.

Circadian Rhythms

Circadian rhythms (CR) synchronize to both the internal and external environment, across different systems, allowing us to respond effectively to what is going on around us and to keep our brains in a stable self-regulating state (homeostasis). With regard to mental illness, there is a lot of serious chicken-and-egg discussion going on. In the words of the NIMH:

Does CR dysregulation lead to mental health problems or do processes that lead to mental health problems also lead to dysregulation of CR?

Bringing it down to our level: Is bipolar disorder really a circadian rhythm disorder? Are our ups and downs just one the spinning wheels in the watch-works? If so, where is the mainspring?

Sleep and Wakefulness

What happens when we go to sleep? Here is an eye-opener: "Sleep is widespread, but does not necessarily occur at the same time in all brain regions and circuits." Moreover, "sleep is not simply a 'not awake' state."

So THAT explains it. Here we are, thinking we've got our neurons all settled in for the night only to discover half of them are out partying. No wonder so many brain cells don't show up for work the next day. Have you ever heard of someone with bipolar who DOES NOT have a major sleep problem?

According to the NIMH: Sleep "has restorative and transformative effects that optimize neurobehavioral functions during wakefulness." I bet we would all like some of that.

Wrapping It Up

Probably the most important thing we can do to manage our bipolar is stick to a regular schedule. Our circadian rhythms respond to prompts from the environment, which include the ones we initiate. The brain (our brains, especially) are sensitive to miscues. Skip breakfast one too many times and we pay with interest.

Sticking to routines, however, is easier said than done, especially if you get a creative idea at bedtime. Now you're in a state of arousal, unable to sleep, a certain no-show for breakfast. For young people, the situation is almost impossible. It is no coincidence that bipolar breaks out during college age, when the last thing kids are doing is keeping a regular schedule.

"Normal" brains, it seems, can tolerate more abuse. They can more easily adjust and reset to normal. A good night's sleep has a way of rebooting the system. Our brains, by contrast, require more careful handling. Our illness, perversely, inclines us in the opposite direction.

Here I am, lecturing you. It's 10 AM. I need to sleep.

This concludes our series on the NIMH's new research agenda. Previous pieces:

Social Interactions

Deconstructing Bipolar - Cognitive Control

Attention and Perception: Two Pieces in the Bipolar Puzzle

Understanding Behavior and Emotions - Let's Look at the Circuitry Beyond the DSM: Thomas Insel and Understanding Mental Illness