The Impact of Stress, Mood Dysregulation, and Sleep Cycle on Bipolar Disorder

Abstract

Bipolar disorder (BD) is a chronic psychiatric condition characterized by alternating episodes of mania/hypomania and depression, contributing to high morbidity and functional impairment worldwide. Recent evidence highlights the interconnected roles of psychosocial stress, emotion regulation deficits, and circadian/sleep disturbances in shaping the onset, recurrence, and severity of bipolar episodes. Stress and hypothalamic–pituitary–adrenal (HPA) axis dysregulation act as key triggers of relapse, while maladaptive mood regulation strategies amplify symptom persistence and comorbidities. In parallel, disrupted sleep and circadian misalignment—driven by genetic and environmental influences—serve as both precipitants and consequences of mood episodes, creating a self-reinforcing cycle of instability. This review synthesizes findings from recent studies (2019–2024) on these three domains, emphasizing their bidirectional interactions and clinical implications. Evidence suggests that integrated interventions—targeting stress management, emotion regulation training, and circadian/sleep stabilization—can reduce relapse risk and improve long-term outcomes when combined with pharmacotherapy. Understanding the stress–mood–sleep nexus is essential for advancing personalized, mechanism-based treatment strategies in bipolar disorder