Harvard Mental Health Letter

Ask the doctor: What is hypomania?

Q. Recently I've been staying up until 3 or 4 in the morning to work on my oil paintings. I know I should feel tired, but I don't. One of my friends said that I might be hypomanic. What is that?

A. Hypomania is usually described as a mood state or energy level that is elevated above normal, but not so extreme as to cause impairment — the most important characteristic distinguishing it from mania. In fact, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for hypomania and mania are almost identical.

The word hypomanic tends to confuse some people, because of the "hypo" prefix. Hypo (from the Greek) means "under," and it is used in this case because this mood state is under, or less manic, than mania. But, compared with normal mood, hypomania is actually higher.

The decreased need for sleep that you describe is one of the hallmarks of hypomania. Some people who are hypomanic sleep only a few hours a day, and yet they say they feel rested. At the same time, many creative people are energetic and while they are in the "flow" may need less sleep than normal. That does not necessarily mean they (or you) are hypomanic except in an informal, descriptive sense.

The formal DSM-IV diagnostic criteria for hypomania require at least three of the following symptoms for at least four days: inflated self-esteem or grandiosity; decreased need for sleep; increased talkativeness; racing thoughts or ideas; marked distractibility; agitation or increased activity; excessive participation in activities that are pleasurable but invite personal or fiscal harm (shopping sprees, sexual indiscretions, impulsive business investments, and the like). For mania, the symptoms are mostly the same, except that the DSM-IV specifies that they last at least one week, lead to hospitalization, or include psychotic symptoms (a break with reality).

Hypomania can occur on its own, whereas mania by definition occurs only in conjunction with bipolar disorder. Moreover, the presence of mania is also what differentiates the two major types of bipolar disorder from one another. In type 1 bipolar disorder, a person usually experiences alternating episodes of depression and mania; in type 2 bipolar disorder — generally considered less severe — a person alternates between depression and hypomania, and has never experienced mania.

If you truly have none of the other symptoms described above, then maybe you are one of the lucky people who can burn the midnight oil without troubling consequences. I have a very productive and successful friend who says he simply never feels tired and is fine with much less sleep than experts recommend. I envy, at the very least, that he has more waking hours to enjoy his life!

But if you run into trouble because of the sleeplessness — it might show up in periods of depressed mood, or relationships or work may suffer, or you may notice some of the other hallmarks of hypomania — then you may want to see a clinician to undergo a psychiatric evaluation and receive treatment.

Severe episodes of hypomania may require mood stabilizers used in treating mania. For mild or moderate episodes, however, it may be possible for a person to deal with hypomania by adopting basic healthy lifestyle habits. That means eating regular meals, doing physical activity every day (a great way to burn off some extra energy), and trying to get at least seven or eight hours of sleep per night. It may also help to learn to recognize common triggers of hypomania, such as sleep deprivation or too much caffeine.

— Michael Craig Miller, M.D.
Editor in Chief, Harvard Mental Health Letter