More sleepless days, a riskier situation

Bipolar disorder holds potential for disaster

Standoff In Dundalk

March 21, 2000|By Jonathan Bor | Jonathan Bor,Sun Staff

Just how long can Joseph C. Palczynski keep going?

The answer, according to some doctors, may be several more days. People can function for extended periods if sleep-deprived, experts say, though they are likely to become more irritable and suspicious. But for someone suffering from bipolar disorder, going days with virtually no sleep can have disastrous consequences.

Since the standoff in Dundalk began Friday night, Baltimore County police believe Palczynski has kept going with only occasional naps.

"Sleep deprivation can only be making the situation worse in terms of how a person under those circumstances is interpreting what is happening and how a person reacts," said Dr. David Neubauer, associate director of the sleep disorders center at Johns Hopkins Bayview Medical Center.

Police have said that Palczynski suffers from bipolar disorder, which is characterized by wide swings in mood from depression to mania. In a manic phase, patients might feel paranoid, euphoric or endowed with superhuman abilities.

Neubauer and another expert who commented on the case said they had no direct knowledge of Palczynski's psychiatric history. They commented more generally on what might happen when manic depression -- another name for bipolar disorder -- is coupled with lack of sleep.

Dr. Kay Jamison, a Hopkins psychiatrist who has written extensively on bipolar disorder, said sleep deprivation can heighten the symptoms of mania.

"Sleep deprivation clearly worsens psychosis," she said. "I don't think there's any way of knowing. Some people will get increasingly psychotic, increasingly paranoid, increasingly disturbed. Some people you can wait out."

Police have said they are hoping that patience will pay off. Perhaps Palczynski will grow tired of the ordeal and give in. Perhaps, if he is in a manic state, he will cycle out of that and begin to see things more rationally.

There is no way, however, to predict how long manic episodes will last, Jamison said.

"They can last from an hour to months," she said. "In the days before mania was treatable, the average length of time of an untreated manic episode was one to three months. They were very extended."

Neubauer said it is useful to consider the case of an otherwise healthy person who goes for long periods without sleep.

A person who misses a night's sleep might not feel profoundly tired the next day. Daylight could trick his biological clock and place him back in his normal rhythm -- the classic "second wind."

As the sun sets, the internal clock cannot be tricked anymore. "They tend to feel kind of irritable, more likely to make mistakes and have accidents and generally have poor concentration."

With each passing day, fatigue tends to lessen in the daytime and worsen at night. But overall, it will grow worse.

"Each daytime will be worse than the last," he said. "Enough sleep deprivation can bring about misperceptions. The startle response increases, and you start to imagine things out of the corner of your eyes, especially at night. Things catch your attention that aren't really there."

To stay awake, a person might drink lots of coffee or take caffeine pills or illegal substances. These might work for a while, but might also make a person angrier and more volatile.

Some people can stay awake for a day or two without drifting off, Neubauer said. Others can go a little longer. In one study, someone stayed awake for 10 days, but that was in a research setting where the subject was intentionally kept awake.

People who try to stay awake when their bodies tell them otherwise tend to get "intrusions of microsleep," similar to what happens when a trucker nods off for an instant, Neubauer said. They might also take cat naps that could last minutes or even hours.

Even soldiers who have endured days of sustained combat can't help but doze off briefly.

A person who catches brief naps can persist for days, he said -- even several days longer than Palczynski has now. How long is impossible to say.

At Walter Reed Army Hospital, researchers found that soldiers who are kept awake for days often lose their ability to make sound decisions and pay attention to detail. Tired soldiers slow and become irritable, though they might still be able to shoot their guns accurately. Soldiers might lose track of their surroundings and either refuse to fire at targets or fire prematurely. These are normal reactions, without the compounding factors of mental illness.

"I can tell you that with someone who has bipolar disorder, sleep deprivation can actually cause a full-blown manic episode," Neubauer said. "Frankly, when we are training [treating] bipolar patients, we make sure they they are regularly getting sufficient sleep. It's an important part of their care."

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