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Lithium or Valproate: Which Is Better for Sleep in Bipolar Disorder?

People with bipolar disorder often struggle with sleep, even when their mood symptoms are under control. Poor sleep increases the risk of relapse into depression or mania. In this study, scientists from the University of Health Sciences in Turkey compared how two common mood stabilizers – lithium and valproate – affect sleep.

The Study: Lithium Is Associated With Better Sleep

Researchers wanted to know whether one of these treatments helps patients sleep better while they are in remission, meaning they are not currently depressed or manic.

The study included 130 adults with bipolar disorder who had been stable on either lithium or valproate for at least six months. Sleep quality was measured using a standard questionnaire called the Pittsburgh Sleep Quality Index. 

Sleep problems were common in both groups, and sleep quality scores in both groups indicated poor sleep.

Patients taking lithium had better sleep efficiency. They spent a higher percentage of their time in bed actually sleeping, rather than lying awake. They also reported fewer nighttime disturbances, such as waking up repeatedly. 

Other aspects of sleep – such as how long it took to fall asleep, total sleep duration, use of sleep medication, and daytime drowsiness – did not differ significantly between the two groups.

Why Might Lithium Have an Advantage? 

Previous research suggests that lithium helps regulate circadian rhythms – the body’s internal clock. It may increase deep, slow-wave sleep and stabilize biological rhythms that are often disrupted in bipolar disorder. 

For patients and clinicians, the takeaway is straightforward: when choosing a maintenance treatment for bipolar disorder, sleep quality may be an important factor to consider alongside mood stabilization, side effects, and overall health.

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