The effect of sleep-wake behaviors on the onset of mania in youth: a computational model

BackgroundBipolar disorder is a recurrent and disabling condition, with a critical clinical need to prevent transitions from euthymia or depression (normal or low activation states) to mania (a high activation state).This study investigates how disruptions in sleep-wake and circadian rhythms may trigger these high activation states, to inform more effective relapse prevention strategies. MethodsWe developed an agent-based computational model integrating empirical evidence, clinical expertise, and lived experience to simulate how 24-hour sleep-wake behaviors (SWB) influence manic episodes.Individual characteristics were drawn from the Brain and Mind Youth Cohort (N=2,330), and multiple scenarios were simulated to assess how SWB dynamics affect the emergence and course of mania. ResultsIn the absence of all irregularities, no individuals experienced a manic episode.Removing behavioural feedback loops resulted in a substantial reduction in manic episodes and delayed onset.In contrast, eliminating light-dark entrainment slightly increased the frequency of manic episodes, suggesting that seasonal adaptation plays a stabilising role.When examining components of SWB separately, removing sleep irregularities alone had only a modest effect on mania rates, whereas reducing activity irregularities led to the largest benefit: a significant drop in mean manic episodes, a delay in onset, and preventing mania in 65% of the simulated agent population. ConclusionsOur findings highlight the value of computational modelling for uncovering causal dynamics in mental health.These specific findings demonstrate how daily irregularities in sleep-wake behaviour may be a necessary condition for mania.Targeting behavioural regularity may offer a powerful pathway for prevention and early intervention.