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The effect of sleep–wake behaviors on the onset of mania in youth: A computational model
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DOI：10.1192/j.eurpsy.2026.10180.png)
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Abstract
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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 a computational agent-based model integrating empirical evidence; clinical expertise; and lived experience to simulate how 24-hour sleep–wake behaviors (SWBs) 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 behavioral 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 stabilizing 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 modeling for uncovering causal dynamics in mental health. These specific findings demonstrate how daily irregularities in sleep–wake behavior may be a necessary condition for mania. Targeting behavioral regularity may offer a powerful pathway for prevention and early intervention.
Keywords:
Agent-based modeling
circadian rhythms
complex systems
bipolar disorder
sleep
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