Bipolar disorder contributes substantially to the global burden of disease. Both sleep disturbance and life events predict symptoms of mania, although the underlying mechanisms associated with these relationships have been difficult to elucidate. In this report, we explore the relationships among life events, sleep disturbance, and mania in an effort to provide support for the hypothesis that some life events lead to a disruption of sleep that may ultimately lead to the development of mania. We present an integrated conceptual model that draws on research examining the mechanisms by which life events disrupt sleep in various populations, and we evaluate the role of these mechanisms in individuals with mania. Suggestions for future work in this area are also presented.

Bipolar disorder contributes substantially to the global burden of disease and has been ranked as the sixth leading cause of disability worldwide (Fajutrao, Locklear, Priaulx, & Heyes, 2009; Murray & Lopez, 2010). The disorder is characterized by manic, hypomanic, mixed, and major depressive episodes (American Psychiatric Association [APA], 2000). The lifetime prevalence rate of bipolar I and II disorders is estimated at 2.1% in the United States (Merikangas et al., 2007). Bipolar episodes are likely to recur, and the disorder is associated with the highest rates of suicide among all psychiatric disorders (Miklowitz & Johnson, 2009).

Both sleep disturbance and life events predict symptoms of mania, although the underlying mechanisms associated with these relationships have been difficult to elucidate. Examining the role of sleep disturbance and life events may help us better understand the underlying mechanisms of bipolar disorder, especially when we consider evidence implicating these factors in the development of bipolar episodes (e.g., Altman et al., 2006; Harvey, 2002; Harvey et al., 2011; Johnson, 2005; Miklowitz & Johnson, 2006; Proudfoot, Doran, Manicavasager, & Parker, 2003). Because our understanding of how sleep disturbance...