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Life Events, Sleep Disturbance, and Mania: An Integrated Model


Address correspondence to Ellen Frank, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, BT 812, Pittsburgh, PA 15213. E-mail:


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.