Mania triggered by sleep loss could be a marker for postpartum psychosis

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  • The risk for postpartum psychosis (PP) should be monitored in women with bipolar disorder (BD) who are pregnant or planning to conceive.
  • Sleep loss with a history of mood dysregulation can be a marker of increased risk for PP.  

Why this matters

  • PP is common during the first 2 postpartum wk and has a sudden onset.
  • Loss of sleep exerts an antidepressant effect by resetting processes that are a result of abnormal clock genes.

Study design

  • This retrospective study evaluated 870 parous women with BD between November 2007 and July 2013.
  • Funding: Stanley Medical Research Institute and others.

Key results

  • 220 women reported sleep loss had triggered mania, 595 reported sleep loss had not triggered mania and 55 were unsure whether sleep loss had triggered mania.
  • Mania triggered by sleep loss and PP showed significant association when separating women based on the first episode experienced in relation to childbirth (OR, 2.91; P=.011) or unrelated to childbirth (OR, 2.45; P<.001).
  • Significantly higher risk for PP was seen in women reporting sleep loss triggering mania (P<.001).
  • Lifetime episode of PP is most common in women reporting sleep loss triggering mania (OR, 2.09; P<.001).


  • Risk for bias.