Sleep Apnea Common Among Rapid Cyclers

Kellen and colleagues presented a poster at the 9th International Conference on Bipolar Disorder (ICBD) held in Pittsburgh in 2011, in which they reported that 21% of patients with rapid cycling bipolar disorder have confirmed sleep apnea. Since many patients who screened positive for sleep apnea on the study’s sleep questionnaire did not undergo follow-up sleep studies to confirm the diagnosis, it is estimated that up to 40% of rapid cycling patients may, in fact, have sleep apnea.

Editor’s note: Given such a high incidence of sleep apnea among rapid cycling bipolar patients, it would be prudent for patients and clinicians to be alert to the possibility of sleep apnea and follow up with appropriate sleep studies. Sleep apnea can cause daytime fatigue, cognitive dysfunction, and treatment resistance, so its identification and treatment with continuous positive airway pressure (CPAP) may be enormously beneficial to a substantial number of rapid cycling bipolar patients. A just-published article by Sukys-Claudino in Sleep Medicine presents findings that compared to placebo, the anti-Alzheimer’s drug donepezil (Aricept) started at 5mg/day for 2 weeks and then increased to 10 mg given twice a day (20 mg/day total) helped all measures of sleep apnea including daytime sleepiness.



Clinical hints that a patient may be suffering from sleep apnea include loud snoring, long pauses between breaths, and non-restorative sleep. The likelihood of sleep apnea increases with age and with overweight or obesity.

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