Sleep Disturbance and Behavioral Changes in a 32-Year-Old Male: Exploring Bipolar Disorder

Case at a Glance

A 32-year-old male presents with chronic sleep disturbances, decreased need for sleep, impulsive spending behaviors, and sustained energy levels lasting approximately 11 months, raising concern for possible bipolar disorder with manic episodes.

Patient's Story

The patient reports a significant change in sleep patterns beginning in August of the previous year, characterized by frequent awakenings every 2-3 hours and a markedly decreased subjective need for sleep. He describes feeling consistently alert and energetic, stating he feels like he can 'keep going and going' without experiencing typical fatigue. The patient has transitioned to overnight work without experiencing normal sleepiness patterns. Additionally, he acknowledges a two-year history of impulsive spending and financial difficulties severe enough to prompt concern from family members. He denies experiencing grandiose thoughts but is troubled by his behavioral changes.

Initial Assessment

The patient underwent comprehensive medical evaluation including brain MRI and polysomnography, both of which revealed no clinically significant abnormalities. His primary care physician initially suggested he might be naturally predisposed to requiring less sleep. However, given the constellation of symptoms and their impact on functioning, psychiatric evaluation was deemed necessary. The patient was referred for both psychiatric consultation and psychotherapy, though appointment availability extended to August.

The Diagnostic Journey

The patient's presentation includes key features suggestive of a manic episode: decreased need for sleep (sleeping only 2-3 hours), increased energy and activity levels, and impulsive behavior manifesting as excessive spending. The temporal relationship between symptom onset and the chronic nature of these changes supports consideration of bipolar disorder. A multiple sleep latency test was ordered to further evaluate sleep architecture and rule out primary sleep disorders.

Final Diagnosis

Pending formal psychiatric evaluation. Working differential diagnosis includes Bipolar I Disorder with consideration of current or recent manic episode, given the presence of decreased need for sleep, increased energy, and impulsive behaviors persisting for nearly one year.

Treatment Plan

Patient scheduled for comprehensive psychiatric evaluation and psychotherapy assessment. Treatment planning deferred pending formal diagnostic clarification. Patient educated about potential mood stabilizing medications and the importance of professional psychiatric management for suspected bipolar disorder.

Outcome and Follow-up

Patient awaiting psychiatric consultation scheduled for August. Interim monitoring by primary care provider for symptom progression and safety concerns. Family involvement noted as supportive given their awareness of behavioral changes, particularly financial impulsivity.