According to research published in January 2018 in the Journal of Affective Disorders, another factor warranting further examination is sleep loss, which has been shown to precede manic episodes in a range of studies. Sleep changes the body’s physiological state. Serotonin, norepinephrine and dopamine are all involved in sleep. Stage 1 is more of a transitional sleep period, while Stage 2 consists of high-voltage positive and negative discharges. Stage 3 is a slow wave period of restorative sleep in which serotonin and norepinephrine are reduced, and Stage 4 is REM sleep. REM sleep is the least restorative of all the stages, causes irregular breathing patterns and also causes a reduction of serotonin and norepinephrine levels in the brain. In terms of brain function during REM sleep, there is increased limbic (emotional) activity and reduced prefrontal (rational) activity. Circadian factors must also be taken into account, for example a daytime nap while the baby is sleeping will not produce the same results as sleep obtained overnight. There are many sleep loss effects on the brain; for instance, sleep loss increases the risk for postpartum psychosis, more so if a person has a previous diagnosis of bipolar disorder.
According to the article, women who report manic episodes triggered by sleep loss could be more vulnerable to developing postpartum psychosis, although additional studies on the topic are needed.
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