In the interest of simplicity, I’m going to look at individual pieces of your and Natalia’s counterarguments. I won’t do it all at once, but I’ll try to be thorough over time. I’ll be separating my analyses into separate comments.
To start with, you say:
Here’s what Mendonça writes in her first point that so conclusively demonstrates that the point I make is “misleading”:
[Guzey’s] evidence from bipolar disorder patients is not representative of what you see in the general population: both long and short sleep duration are associated with depression
The paper Mendonça cites looks at long-term long sleep and long-term short sleep, with their association with depression. My claim and my evidence (from bipolar people) are concerned with short-term long sleep and short-term short sleep. That is, Mendonça’s paper is simply not overlapping with with what I write about or what the evidence she calls “misleading” is concerned about.
To break this into parts:
My claim and my evidence (from bipolar people) are concerned with short-term long sleep and short-term short sleep.
Bipolar I Disorder is defined by manic episodes that last at least seven days (most of the day, nearly every day) or when manic symptoms are so severe that hospital care is needed. Usually, separate depressive episodes occur as well, typically lasting at least two weeks. Episodes of mood disturbance with mixed features (having depression and manic symptoms at the same time) are also possible.
Bipolar II Disorder is defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above.
None of the respondants from the r/BipolarReddit thread you quoted specify if they have BP I or BP II. However, if some have BP I, then the length of their depressive episodes fit within the diagnostic criteria for atypical depression.
Two or more of the following features, present for most of the time, for at least two weeks:
Increased appetite
Increased sleep
Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
Interpersonal rejection sensitivity (not limited to episodes of mood disturbance) resulting in significant social or occupational impairment
You say:
The paper Mendonça cites looks at long-term long sleep and long-term short sleep, with their association with depression. That is, Mendonça’s paper is simply not overlapping with with what I write about.
The paper Natalia cites is the one I just quoted. It specifically covers sleep in bipolar I patients with atypical depression, which is directly overlapping with your topic.
Your argument in this section is setting up a model in which depression/long sleep and mania/short sleep are at two ends of a sliding scale in the general population. Your BipolarReddit anecdotes are meant to establish the polar ends of this scale, and the use of sleep deprivation as a depression treatment is meant to establish the causal role of sleep length in moving us from one end to the other of the scale in the general population. Natalia’s counterargument is that there doesn’t exist a simple depression/high sleep—mania/low sleep scale in the general population. Using bipolar patients gives a misleading impression that there is such a simple scale.
I think, however, that the most important point you’re trying to make here is that “less sleep can be good for you,” using the example of sleep as depression treatment as an example, as well as the existence of atypical depression. Here, the simple scale does generate useful results. There’s evidence (accessible on sci-hub) that sleep deprivation works better as a treatment for depression with melancholic features (coinciding with shortened sleep and sleep disturbance) than for depression with atypical features.
Researchers and clinicians agree that the effect of SD is most favorable in patients with the classical ‘endogenous (endogenomorphic)’ depressive syndrome. In terms of DSM-IV these patients fulfil the criteria of a major depressive episode (with melancholic features). Less favorable SD effects have been observed in dysthymic patients (formerly neurotic depression). However, these differences are not very pronounced according to the metaanalysis published by Wu and Bunney (1990); who determined a response rate of 67% in endogenous depression compared with 48% in neurotic depression...
So even for patients not sleeping very much (those with melancholic features), the right move can be a careful regimen of getting even less sleep. A simple “depression → healthy” scale works when we consider this specific sleep intervention. If sleep deprivation can also trigger manic episodes in bipolar patients, as you both seem to agree it does, we also have a “healthy → manic” piece of the scale as well.
Sleep compression and restriction is also used as a treatment for insomnia. From the sleep foundation (not a great source, but I think this is an OK as a description of the technique):
Sleep restriction and compression: These two methods aim to improve sleep quality and quantity by reducing the amount of time a person lies in bed. A CBT-i practitioner can use records from a patient’s sleep diary to determine how much time they sleep each night compared to the amount of time they lie in bed awake. Sleep restriction involves a sharp curtailing of time in bed while sleep compression is a more gradual process, but both techniques are intended to achieve the same goal: less time in bed awake each night.
I think this highlights that we need to distinguish between “spending more time in bed” and “getting more sleep.” More on this later.
None of the respondants from the r/BipolarReddit thread you quoted specify if they have BP I or BP II. However, if some have BP I, then the length of their depressive episodes fit within the diagnostic criteria for atypical depression.
Two or more of the following features, present for most of the time, for at least two weeks:
Increased appetite
Increased sleep
Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
Interpersonal rejection sensitivity (not limited to episodes of mood disturbance) resulting in significant social or occupational impairment
The difference between BP II and BP I doesn’t matter in respect to this. You need to have depressive episodes at least 2 weeks in length to be diagnosed with BP II.
In the interest of simplicity, I’m going to look at individual pieces of your and Natalia’s counterarguments. I won’t do it all at once, but I’ll try to be thorough over time. I’ll be separating my analyses into separate comments.
To start with, you say:
To break this into parts:
There are several types of bipolar, including bipolar I and bipolar II.
None of the respondants from the r/BipolarReddit thread you quoted specify if they have BP I or BP II. However, if some have BP I, then the length of their depressive episodes fit within the diagnostic criteria for atypical depression.
You say:
The paper Natalia cites is the one I just quoted. It specifically covers sleep in bipolar I patients with atypical depression, which is directly overlapping with your topic.
Your argument in this section is setting up a model in which depression/long sleep and mania/short sleep are at two ends of a sliding scale in the general population. Your BipolarReddit anecdotes are meant to establish the polar ends of this scale, and the use of sleep deprivation as a depression treatment is meant to establish the causal role of sleep length in moving us from one end to the other of the scale in the general population. Natalia’s counterargument is that there doesn’t exist a simple depression/high sleep—mania/low sleep scale in the general population. Using bipolar patients gives a misleading impression that there is such a simple scale.
I think, however, that the most important point you’re trying to make here is that “less sleep can be good for you,” using the example of sleep as depression treatment as an example, as well as the existence of atypical depression. Here, the simple scale does generate useful results. There’s evidence (accessible on sci-hub) that sleep deprivation works better as a treatment for depression with melancholic features (coinciding with shortened sleep and sleep disturbance) than for depression with atypical features.
So even for patients not sleeping very much (those with melancholic features), the right move can be a careful regimen of getting even less sleep. A simple “depression → healthy” scale works when we consider this specific sleep intervention. If sleep deprivation can also trigger manic episodes in bipolar patients, as you both seem to agree it does, we also have a “healthy → manic” piece of the scale as well.
Sleep compression and restriction is also used as a treatment for insomnia. From the sleep foundation (not a great source, but I think this is an OK as a description of the technique):
I think this highlights that we need to distinguish between “spending more time in bed” and “getting more sleep.” More on this later.
The difference between BP II and BP I doesn’t matter in respect to this. You need to have depressive episodes at least 2 weeks in length to be diagnosed with BP II.
From the DSM-5, which you can find on libgen:
Thanks for pulling that up. This makes the point you and I are making even stronger in this area.