In this Article
In this Article
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- How Bipolar Disorder Affects Sleep: Get Better Sleep With Bipolar Disorder
- How Bipolar Disorder Affects Sleep
- Get Better Sleep With Bipolar Disorder
How Bipolar Disorder Affects Sleep: Get Better Sleep With Bipolar Disorder
Changes in sleep that last for more than two weeks or interfere with your life can point to an underlying condition. Of course, many things may contribute to sleep problems. Here’s what you need to know about the many connections between bipolar disorder and sleep and what you can do to improve your sleep.
How Bipolar Disorder Affects Sleep
Bipolar disorder may affect sleep in many ways. For example, it can lead to:
- Insomnia, the inability to fall asleep or remain asleep long enough to feel rested (resulting in feeling tired the next day).
- Hypersomnia, or over-sleeping, which is sometimes even more common than insomnia during periods of depression in bipolar disorder.
- Decreased need for sleep, in which (unlike insomnia) someone can get by with little or no sleep and not feel tired as a result the next day.
- Delayed sleep phase syndrome, a circadian-rhythm sleep disorder resulting in insomnia and daytime sleepiness.
- REM (rapid eye movement) sleep abnormalities, which may make dreams very vivid or bizarre.
- Irregular sleep-wake schedules, which sometimes result from a lifestyle that involves excessive activity at night.
- Co-occurring drug addictions, which may disrupt sleep and intensify pre-existing symptoms of bipolar disorder.
- Co-occurring sleep apnea, which may affect up to a third of people with bipolar disorder, which can cause excessive daytime sleepiness and fatigue.
During the highs of bipolar disorder (periods of mania), you may be so aroused that you can go for days without sleep without feeling tired the next day. For three out of four people with bipolar disorder, sleep problems are the most common signal that a period of mania is about to occur. Sleep deprivation, as well as jet lag, can also trigger manic or hypomanic episodes for some people with bipolar disorder.
When sleep is in short supply, someone with bipolar disorder may not miss it the way other people would. But even though you seem to get by on so little sleep, lack of sleep can take quite a toll. For example, you may:
- Be extremely moody
- Feel sick, tired, depressed, or worried
- Have trouble concentrating or making decisions
- Be at higher risk for an accidental death
You may already know the ups and downs of how bipolar disorder affects sleep. But even between acute episodes of bipolar disorder, sleep may still be affected. You may have:
- Heightened anxiety
- Worries about not sleeping well
- Sluggishness during the day
- A tendency to have misperceptions about sleep
Get Better Sleep With Bipolar Disorder
Disrupted sleep can really aggravate a mood disorder. A first step may be figuring out all the factors that may be affecting sleep and discussing them with your doctor. Keeping a sleep diary may help. Include information about:
- How long it takes to go to sleep
- How many times you wake up during the night
- How long you sleep all night
- When you take medication or use caffeine, alcohol, or nicotine
- When you exercise and for how long
Certain bipolar medications may also affect sleep as a side effect. For example, they may disrupt the sleep-wake cycle. One way to address this is to move bedtime and waking time later and later each day until you reach your desired goal. Two other ways to handle this situation are bright light therapy in the morning and use of the hormone melatonin at bedtime, as well as to avoid bright light or over-stimulating activity near bedtime. This can include exercise and TV, phone, and computer screens.
Of course, your doctor may recommend a change in medication if needed. Be sure to discuss any other drugs or medical conditions that may be affecting your sleep, such as arthritis, migraines, or a back injury.
Restoring a regular schedule of daily activities and sleep — perhaps with the help of cognitive behavioral therapy — can go a long way toward helping restore more even moods.
Steps like these may also help restore sleep:
- Eliminate alcohol and caffeine late in the day.
- Keep the bedroom as dark and quiet as possible and maintain a temperature that is not too hot or cold. Use fans, heaters, blinds, earplugs, or sleep masks, as needed.
- Talk with your partner about ways to minimize snoring or other sleep habits that may be affecting your sleep.
- Exercise, but not too late in the day.
- Try visualization and other relaxation techniques.
- Try to unplug from the TV, laptop or your phone earlier.
Depression and Bipolar Support Alliance: “Sleepless in America: Are You Moody or Irritable?;” В “Sleepless in America: Information for Families;”В and “Sleepless in America: What’s Keeping You Up All Night?”
Fieve, R. Bipolar II:Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression–The Essential Guide to Recognize and Treat the Mood Swings of This Increasingly Common Disorder, Rodale Books, 2006.
Harvey, A. American Journal of Psychiatry, 2005.
Manic episodes are a symptom of bipolar disorder. A manic episode is considered the ‘high’ point on the bipolar spectrum. A manic episode causes a person to become very excitable and irritable. These episodes can last anywhere from a few days to several months.
A patient will feel very energetic and restless during a manic episode. He or she will likely be irritable and talkative. It will often sound like rambling, and it can become so intense that it frightens friends and family. The irritability and talkative or obsessive thoughts often come from racing thoughts that are often nonsensical or grandiose.
A patient who is experiencing a manic episode may set unattainable or unusual goals, express intense enthusiasm and commitment to achieving these goals, and become very agitated if confronted with the erratic and intense behavior, or confusion about the intensity of the unusual or grandiose sense of the ability to attain the goals.
People who are experiencing a manic episode may think people are trying to harm them in some way. They will likely be unable to focus. They will be unreceptive to people trying to help them, and will likely become suspicious of the efforts to help. Someone who is experiencing a manic episode may even become aggressive toward people who express concern for him or her.
A manic episode will affect a patient’s sleep cycle. He or she will sleep very little. The patient experiencing a manic episode may even go for entire days without sleeping. This little need for sleep, erratic behavior and high energy despite the sleep deprivation can make friends and loved ones assume that the manic patient is under the influence of drugs.
A manic episode can cause a patient to make poor decisions. Some examples are actually using drugs, engaging in promiscuous or dangerous behavior, or picking fights with people. This is because during a manic episode a patient will feel invincible. They will likely have a sense of exaggerated confidence. They may even believe they have abilities to engage in these activities with no risk of being hurt. This often causes tension with the manic patient and concerned loved ones, along with innocent bystanders.
During a manic episode a patient can experience psychotic symptoms, like:
- Hallucinations. Seeing or hearing things that are not there or do not exist. Symptoms of hallucinations include having imagined sensations throughout the body. Some examples are voices telling you unsettling things or seeing shadows or people who are not actually there. Hallucinations can also cause people to smell things that are not real or feel things that are not there.
- Delusions. False or imagined perceptions of reality. Signs of delusions include paranoid behavior. Delusions also include grandiose beliefs in self. Delusions can cause the beliefs of being betrayed by people close to them, that someone is trying to stalk them, capture them, or harm them.
Sometimes patients with bipolar disorder will not experience mania. They may instead experience episodes hypomania. “Hypomania” means the symptoms of ‘mania’ are not as severe as the typical manic state. Patients who experience hypomania likely have a bipolar II diagnosis. Both mania and hypomania have the potential to be dangerous to the patient and people around them. That is why it is important to seek medical or psychiatric intervention if a patient is experiencing a manic episode.
Effectively managing bipolar disorder includes knowing the early signs of an episode. It also means having a plan to address these signs before they escalate into hypomania, mania or depression.
According to authors Janelle M. Caponigro, MA, Eric H. Lee, MA, Sheri L. Johnson, Ph.D, and Ann M. Kring, Ph.D, in their book Bipolar Disorder: A Guide for the Newly Diagnosed, common warning signs of mania or hypomania include: feeling irritable, sleeping less, having more energy, driving faster, talking faster, starting new projects, feeling more self-confident, dressing differently, having increased sexual feelings and feeling impatient.
Every person has his or her own unique warning signs. For instance, you might notice that your day is filled to the brim with activities, and you stop taking breaks. You might start spending several hundred dollars on items you don’t need. And others might comment on how overly enthusiastic you are.
To figure out your warning signs, think back to your latest manic episode and what symptoms and experiences precipitated it. It’s also helpful to ask others for input and keep a daily mood chart.
When you’re noticing these warning signs (or you just don’t feel like yourself), the authors recommend contacting your treatment team.
They also elaborate on three types of strategies to employ when signs point to a hypomanic or manic episode: calming yourself; protecting against negative behaviors (such as overspending); and managing medications and therapy.
Here are suggestions from Bipolar Disorder for each type of strategy to help you manage warning signs and prevent a full-blown manic episode.
- Get at least 10 hours of sleep per night. Interestingly, before today’s medications for bipolar disorder were developed, sleeping was one of the chief treatments for mania. “In fact, sleeping for a long time for three or four days in a row can be enough to restore mood and prevent relapse.” If you have a hard time falling asleep, rest in a quiet room (without any technology or other distractions).
- Limit your activities and tasks. If you’re not able to scale back, focus only on the most important activities.
- Don’t spend any more than six hours being active each day. Spend the rest of the time relaxing.
- Don’t try to exhaust yourself. Trying to tire yourself out through exercise or other kinds of stimulating activities actually doesn’t quiet energy; it just increases it.
- Avoid stimulating surroundings. This includes crowded parties, shopping malls and any other places you find energizing.
- Avoid stimulating foods and beverages. Avoid coffee, soda, energy drinks and any vitamins or over-the-counter medication with caffeine.
- Avoid drugs and alcohol. The authors suggest cutting out alcohol entirely when you’re noticing symptoms.
- Engage in calming activities. This includes taking a walk, practicing yoga, breathing deeply and listening to relaxing music.
- Create a list of go-to activities that help to slow you down. These are small actions, such as talking to a friend who calms you.
Protecting Against Negative Behaviors
- Limit your spending. For instance, you might ask your credit card company to lower your limit or ask a loved one you trust to keep your credit cards for a certain time.
- Postpone big decisions. Wait until you can review them with your treatment team or a trusted loved one. Also, give yourself a day to reflect on the pros and cons of a potential decision.
- Avoid letting yourself feel high “a little longer.” Remember, the higher you go, the harder you’ll fall. Working to minimize early warning signs sooner helps you prevent symptoms from progressing into an episode.
- Ask trusted loved ones to tell you if your behavior is out of the norm.
- Avoid putting yourself in potentially triggering situations. These include new romances, unsafe sex and conflict.
Managing Medication and Therapy
When people with bipolar disorder are hypomanic or manic, they commonly think they don’t need their medication. However, instead of not taking your medication (this can be dangerous), consult your prescribing physician. They may change or increase your medication, which can help to stave off a manic episode.
If you’re working with a therapist, you might want to increase your appointments or move them to an earlier time or day.
Bipolar disorder is a serious illness, and it can be tough to pinpoint your warning signs and to manage them. But by thinking ahead, brainstorming with your treatment team and having a plan of strategies that work for you, you can get better and stay well.
Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
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What do you need to know about sleep and sleep patterns when you have bipolar disorder? If you’ve found that your sleep patterns abnormal, for example, if you either sleep 12 to 14 hours at a time or stay up all night, you may find that changing the way you sleep can substantially improve your condition. Studies tell us that sleep issues can have a profound impact on those with bipolar disorder or even those at risk for bipolar disorder.
Before talking about how sleep habits affect bipolar disorder, however, let’s look at this from the other side. How does bipolar disorder affect sleep?
Bipolar Disorder, Depression, and Sleep Problems
Sleep disturbances are very common in people with bipolar disorder and appear to play an important role in the cycling of the disorder.
- Insomnia – Insomnia includes not only difficulty in falling asleep, but difficulties staying asleep or getting too little sleep. Insomnia is common with many physical and mental health conditions. In those with bipolar disorder, hypomania and mania can often lead to insomnia. When this occurs, treatment of the underlying condition (hypomania or mania due to bipolar disorder) is a goal of treatment.
- Delayed sleep phase syndrome – Delayed sleep phase syndrome is a circadian rhythm disturbance. It can be associated with depression and other mental health issues, but is most prominent in adolescents.
- Irregular sleep-wake schedule – When people with bipolar disorder have a lack of a sleep routine, the irregular cycle can greatly interfere with appropriate treatment of the disorder. Treatment focuses on treating the cause which keeps them up at night.
- Nightmares – Vivid dreams, nightmares, and night terrors may also affect people with bipolar disorder. As with insomnia, the goal of treatment is to best treat the underlying bipolar disorder.
It’s clear that bipolar disorder can lead to sleep disorders, but what about the opposite scenario? Can sleep problems lead to or precipitate bipolar disorder in those at risk for the condition?
Sleep as a Precipitant of Mania with Bipolar Disorder
What may surprise you is that reduced sleep isn’t just a symptom of mania—a short night can actually precipitate manic and hypomanic episodes.
Studies have found that 25 to 65 percent of people with bipolar disorder who had a manic episode had experienced a social rhythm disruption prior to the episode. “Social rhythm disruption” is some disturbance in routine affecting the sleep/wake cycle; it can be as simple as staying up extra late to watch a movie on television or getting wrapped up in an interesting online chat session, or as serious as being unable to sleep due to a family member’s serious illness or death.
“For reasons we have yet to learn, people with bipolar disorder seem to have more delicate internal clock mechanisms,” said Dr. Ellen Frank, who has extensively studied these issues.
Could Sleep Disorders Actually Lead to Bipolar Disorder?
Some scientists speculate that one reason the incidence of bipolar disorder has risen in modern times is the development of bright artificial light. Once upon a time, most people’s sleep/wake cycles were regulated by the sun. The artificial light changed all that and made it more likely that people who have a genetic predisposition toward bipolar disorder would actually develop the condition.
While a causal relationship hasn’t been proven, sleep disturbances in people with bipolar disorder have also been linked with changes in the microstructure of the white matter of the brain.
How to Cope
Just as sleep disturbances due to bipolar disorder need to be addressed, those sleep disturbances which could worsen bipolar disorder need to be addressed as well.
If you’re suffering from insomnia, good sleep hygiene is critical. Experts recommend that you:
- Go to bed and get up at the same time every day
- Avoid naps, especially naps in the late afternoon. If you must nap, try to limit your rest to around one hour.
- Use your bedroom for sleep and sex only.
- Avoid heavy meals a few hours before retiring.
- If you can’t sleep after a certain amount of time (for example, 15 minutes) get out of bed and do something. It’ still important to get up at your regular time the next morning, even if you will have less than seven hours of sleep.
If you are coping with hypersomnia (sleeping too much,) it’s often advised that you gradually reduce the amount of time you spend sleeping by using an alarm clock.
Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may be of particular help for treatment-resistant rapid cycling bipolar disorder. Such therapy may begin by enforcing complete light and sound deprivation for as many as 14 hours per night, which can be gradually reduced once a person’s moods are seen to stabilize.
Psychotherapy and medications can also play an important role in improving sleep habits, and in doing so, bipolar disorder symptoms as well.
Involving Your Family in Your Sleep Habits
Doctors point out the need to involve a person’s family in the effort to regularize the sleep/wake cycle. Family members should be taught about the vulnerability to changes in daily routine experienced by people with bipolar disorder. This awareness is critical as a partner’s well-intentioned, “I know the party will last all night but can’t we do it just this once?” could nudge a person with bipolar disorder straight into a manic episode. It can also help for family members to learn the signs of an episode’s onset, whether manic, hypomanic, or depressive and be prepared to intervene before the mood swing becomes full-blown.
If you or a loved one suffer from any type of mood disorder, pay attention to the sleep/wake patterns of the person involved. If you identify insomnia, hypersomnia, poor-quality sleep and/or reduced need for sleep, this should be brought to your/your loved one’s doctor’s attention right away. Treating the sleep disorder is likely to significantly help the mood disorder as well.
On This Page:
- Symptoms of Manic Episodes
- Communication During Mania
- Reducing Harm During Mania
- Compassionate Follow-Up for Mania
- Finding Help for Bipolar Intervention
- Continue Reading
According to the National Institute of Mental Health, more than 4 percent of all adults in America experience bipolar disorder at some time in their lives. 1 While all of these people might share the same diagnosis, their symptoms might be radically different. For example, some people with bipolar disorder feel depressed much of the time. Others have episodes of mania as well as episodes of depression.
Manic episodes can be frightening, and families are often required to provide assistance to help their loved one move through manic days without any long-term harm.
Open discussions, both with the person who has the disorder and with the person’s health care team, are a key part of family support. Understanding more about manic episodes, how they begin and their symptoms can help families prepare an intervention before things spiral out of control.
Symptoms of Manic Episodes
A manic episode is typically associated with a feeling of happiness and power. People in the midst of an episode feel joyful and outgoing and are willing to talk to almost anyone about anything. They might take on a new project, like opening a business or traveling around the world. They might also believe their success is inevitable.
People in the midst of mania also tend to be distractible, moving from one thought or project to another without completing anything. They’re struck by feelings of urgency, as though they must act now before the opportunity is gone.
Communication During Mania
Medical intervention is important when your loved one shows signs of the onset of a manic episode. Medication dosage adjustments might be required to bring the episode to an end, and therapeutic supervision might be necessary to keep someone from causing long-term harm during mania. But convincing your loved one to see the doctor can be difficult.
During mania, thoughts are scrambled and the needs of others fade into the background. People who feel mania are unable to focus on the thread of a conversation, and they may interrupt, argue or otherwise change the subject when family members want to talk. Their mental illness stands in the way of the type of conversation that takes place during a traditional intervention.
In addition, symptoms of mania can grow stronger if the person feels attacked or stressed. They’re unable to think clearly, and when they feel pressure, they might grow even more agitated and upset. Putting someone like this into a high-pressure conversation could result in disaster. That’s why one-on-one, non-threatening conversations might be a better approach during a manic episode.
The following steps can help:
- Suggest that a trip to the doctor is in order and offer to go along for the appointment.
- Bring up the issue repeatedly, but in short little bursts that are heavy on acceptance and understanding and light on blame or judgment.
- Talk on the go, if the person has a lot of energy, or in a quiet, non-stimulating room during a brief moment of peace.
Reducing Harm During Mania
While some people are able to see the wisdom in a call for care during a manic episode, some people are overwhelmed by feelings of power and don’t understand they might cause harm. The mania tells them that they’re powerful and great, and that might contradict with the family’s message of concern. That’s why those in the midst of a manic episode won’t get help at all.
If these steps don’t help and your loved one’s behavior could result in some type of harm, involuntary hospitalization might be required. The DBSA suggests that this should be used as a last resort, only when the person absolutely will not get help and when harm is eminent. However, this could be a vital step some families must take when gentle persuasion and protection fall short. 2
Compassionate Follow-Up for Mania
While formal interventions during manic episodes may not be appropriate, manic days often provide families with the details that make intervention powerful. That’s why keeping notes during a manic episode is vital. Families should write down everything, with as much detail as they can, so they can access those moments when their loved one is calm and a formal intervention can happen.
If an intervention doesn’t help it’s important for families to pay attention to their own mental well-being. Often caregivers who have poor stress control that care for people who struggle to follow their treatment programs tend to increase the chance that serious bipolar symptoms break free. 3
Support groups and individual counseling can help to improve the health and overall well-being of the entire family unit.
Finding Help for Bipolar Intervention
Approaching a loved one with bipolar disorder during a manic episode can be overwhelming. Clinically trained interventionists with experience in treating people with this type of mental illness can help.
Our admissions coordinators can help you find a professional with the clinical mental health expertise that can help your family to heal. Call our helpline 24 hours a day at 615-490-9376.
Ups and downs are natural in any romantic relationship, but when your partner has bipolar disorder it can feel like you’re on an emotional rollercoaster. Not knowing what to expect each day is stressful and tiring. Over time, it wears on the relationship.
Understanding why your partner acts out sometimes or becomes withdrawn is the first supportive step you can take in strengthening your relationship. Learn exactly what a bipolar diagnosis means, how it could affect your partner’s behavior and what you can do to foster a healthy, stable relationship.
What does it mean if your partner is bipolar?
Bipolar disorder is a mental health condition marked by intense mood changes. People with the illness switch back and forth from mania or hypomania (an emotional state of being energetic and gleeful or sometimes aggressive or delusional) to having episodes of depression.
The lifelong condition tends to run in families, although the cause of bipolar disease is unknown. However, it can often be successfully managed through treatment. There are two primary types of bipolar disorder:
Bipolar 1 is a more severe form of the illness and is defined by manic episodes that have one of these characteristics:
- Hallucinations, delusions or paranoia
- Hospitalization required for safety
- Impulsive behavior with significant consequences
“When people are manic, they pursue pleasurable activities with great enthusiasm and with no regard for the consequences,” says Jennifer Payne, M.D., psychiatrist and director of the Women’s Mood Disorders Center at Johns Hopkins Medicine. “They may gamble, spend excessive amounts of money, use drugs or become promiscuous.”
People with bipolar 2 experience hypomanic episodes, which still include out-of-character behavior but aren’t as extreme as those with bipolar 1. Hypomanic episodes may include:
- Increased energy and drive.
- Rapid speech.
- Decreased need for sleep.
“During hypomanic episodes, a partner with bipolar 2 may obsessively pursue sex with you or others,” says Payne. “They may stay up all night and have lots of wonderful ideas they want to tell you about at 3 a.m.”
Bipolar disorder is usually treated with a combination of medications and therapy. However, successful treatment can be a challenge since many people miss the euphoria and energy of manic episodes.
Often people with bipolar disorder view these elevated mood states as their best selves — when they’re the most productive or creative — and will stop treatment in order to experience that again. Sometimes those with bipolar disorder will even intentionally trigger a manic episode.
“Lack of sleep is a trigger of manic episodes for a lot of people,” says Payne. “Sometimes patients with bipolar disorder will deliberately skip getting the sleep they need in order to initiate an elevated mood state. For example, a person might want the high energy that comes with a manic episode to get a project done.”
The key to your partner’s successful management of the illness is a commitment to continuing treatment and ongoing communication with their psychiatrist. This can take place at therapy sessions, during regular checkups or whenever necessary to discuss troubling symptoms.
Many people with bipolar 1 do well on lithium, a mood-stabilizing drug. Those with bipolar 2 may not fully respond to medications often used to treat bipolar disorder. If that’s the case for your partner, it’s important for them to continue to work with their psychiatrist to find an effective treatment.
Being in a Relationship with Someone Who Is Bipolar
There are certainly challenges in any romantic relationship, but bipolar disorder can make things especially difficult in various aspects of life:
It’s common for people with bipolar disorder to desire frequent sex during manic or hypomanic phases. Your partner may initiate intimacy much more than normal, or masturbate or use pornography more frequently than usual. Those with bipolar disorder may also engage in risky behaviors such as unprotected sex or extramarital affairs while manic.
During episodes of depression, your partner may avoid sexual contact altogether. This can be confusing or feel like rejection, especially if your partner recently desired lots of sexual activity during a manic or hypomanic period. Many medications for bipolar disorder can also lower sex drive.
Your partner’s ability to perform well at work can be affected by bipolar disorder. Severe mood swings, along with manic symptoms such as poor judgement and impulsivity, or depressive symptoms such as low energy and disinterest make it tough to find and maintain a job. Stressors at work may also trigger or exacerbate your partner’s symptoms. If your partner can’t hold down a job, this could put more pressure on you to provide financial support until their illness is well-managed.
Many people consider parenting the most stressful (albeit rewarding) job of their lives. But any kind of stressor — good or bad — has potential to trigger manic or depressive episodes for people with bipolar disorder.
In addition, the erratic behavior associated with bipolar disorder can be confusing and scary to children, who look to parents to provide stability. Helping your partner get and maintain treatment to control symptoms is crucial for providing a safe and secure home for children.
How to Make a Bipolar Relationship Work
It takes effort to keep any relationship strong, but it can be especially challenging when your partner has bipolar disorder. Payne offers these recommendations:
Go to Couples Counseling
Couples counseling is essential for working through upset over a bipolar partner’s actions. It’s common for someone with bipolar disorder to hurt and offend their partner. When someone is first diagnosed, there are often relationship issues that need to be addressed. Couples counseling can help you:
- Understand that there’s an illness involved in the hurtful behavior.
- Forgive the behavior that happened during an altered mood state.
- Set boundaries with a partner about maintaining treatment.
Get Involved with Treatment
Ask if you can be involved with your partner’s treatment, which may include occasionally going to the psychiatrist together. Being a part of your partner’s treatment has multiple benefits, including:
- Gaining a better understanding of the illness.
- Providing additional insight for the psychiatrist.
- Learning to spot signs of impending episodes.
- Alerting the psychiatrist about mood changes.
Even if your partner hasn’t signed off on you exchanging information with their psychiatrist, you can still report worrisome signs (the doctor just won’t be able to tell you anything). This gives the doctor a chance to make quick medication changes that may help your partner avoid being hospitalized.
Self-care gets a lot of buzz these days, but nowhere is it more important than when you’re caring for someone with a serious illness such as bipolar disorder. It’s essential to dedicate time to your own physical and mental health, whether that’s going to a support group, talking to a therapist or attending a yoga class.
Being in a healthy relationship with someone with bipolar disorder requires not only careful management of their illness, but also setting aside time to take good care of yourself.
Stop a manic episode in its tracks with expert-recommended strategies.
Manic Episode Warnings Are Unique to You
If you have bipolar disorder, part of treatment includes finding ways to manage and reduce manic episodes. Common symptoms that can signal a manic episode include changing sleep patterns, increasing speed of thoughts and ideas, feeling more upbeat and energized or irritable than usual. But other warning signs will be unique to you.
“The first signs of mania are often personal and individualized,” said bipolar expert Melvin McInnis, MD, a psychiatry professor at the University of Michigan Medical School in Ann Arbor. Try these strategies to identify your personal warning signs and prevent manic episodes.
Keep a Diary
The best way to identify your personal red flags is to keep a log of your thoughts and actions. With the help of a therapist or psychiatrist, you can identify the ones that are important to track as potential signals for an impending manic episode. Over time, you’ll start to notice patterns and be better able to recognize when it’s time to take precautions. As a side note, listen to the people around you when they start to express some worry about your changing behaviors.
Fixing relationships with those you may have hurt during a mood episode is never easy, but believe me: it is possible. And you can!
Many of us with bipolar disorder make terrible decisions when we are ill, and rebuilding our lives afterward is naturally overwhelming—especially after a massive episode, when extreme mania and psychosis might have put you in the hospital, or jail (or both). Talking with creditors, school, work, and those you may have hurt is never easy, but I can say from personal experience that life can be even better than it was before if you face the rebuilding head-on, no matter how much it might hurt.
Bipolar is such a selfish illness: My depression, … my massive manic episode. But if your own personal experience is your sole focus, rebuilding will be tough. I learned this the hard way. I lost husbands, careers, friends, and a whole lot of money because of bipolar episodes. I cried, complained, and told anyone who would listen, “No one understands my pain!” This went on for years. The day I finally turned the focus off myself and onto other people and their needs, my life changed for the better.
Massive episodes—like the time I dumped my partner and took off for China on my own with basically no money—deeply affect the people around you, and it takes a lot for them to get over it. Expanding your vision to think about what other people in your life went through when you were ill and what they need during your rebuilding is critical. Even if you’re feeling fragile or ashamed, opening yourself up to the experiences of others and letting them know that you understand their perceptions can make all the difference. Here’s an example of what you can say to loved ones if bipolar just threw your life—and as a result, theirs—upside down:
I’m tired and worn out from these mood swings. I have no idea how I’m going to get through this, but I want you to know that I’m going to give it all I have. I have a diagnosis now and some answers. I know you went through something as well, and I promise that when I’m feeling better, we can explore how it was for you and what I can do to make things better. For now, I could use your help in getting this illness under control. I am thinking of you and your needs as well as my own.
Rebuilding a professional relationship takes guts, when all you want to do is hide under the nearest rock and stay there. Here’s an example of what you can say if you’re trying to salvage a career after a particularly nasty episode. Once again, acknowledge what it was like for the other person and put yourself in their shoes:
I know that my illness and the behavior it caused was very hard on you. I left work in a way that was probably confusing and very upsetting. I said things no one would choose to say to someone in a business setting. I finally have answers for why this happened, and I am open to any questions you may have. Please know that I understand that it’s now my job to keep myself well, and I have a plan in place to make sure this happens. I would like to talk with you about how we might work together in the future if I can show you through my actions that I’m getting the help I need.
In terms of relationships, especially with family and partners, people want and need—and deserve—to know how you’re going to take care of yourself when you say you want to rebuild your life. For myself, I watch my lifestyle closely, especially regarding sleep and relationships, and I understand my triggers and avoid them.
Saying the right things matters, but unless words are accompanied by action, people will tend to stay away. Whether you were just diagnosed or you need to rebuild once again, be bold and approach this with your head high. Build your self-awareness, and also your consideration of others. A life that seemed destroyed by bipolar can become a life where people want to work and be with you because you know who you are, what you need, and how to take care of yourself. This is your gift to the world, built out of your pain.
Printed as “Fast Talk: Damage Control,” Spring 2016
About the author
What is the solution for the embarrassment one has caused themselves during a manic moment? Twice I posted inappropriate things on Facebook accounts during my mania…once on my own account and once on my brother’s. I seriously have considered ending my life but will not do so….just cannot imagine being this way forever. I have apologized to my brother and he accepted but I cannot forgive myself. Trauma did all of this to me. I am 62, was an award winning employee at my job and had just retired when trauma struck.
Trying to find the right meds.
Thanks Julie, a helpful article.
My my recent massive breakdown with/physcosis… Along with onset of menopause some of suspect was due to the result of to much stress. With being a mother of 3 teen girls the oldest severe bipolar and other issues…and the youngest with social anxiety. Their father has worked 60 + since the 1st was born to this day. I’m the only driver. I do everything but the finances,shope and ask permission for the important stuff. But I can raise the kids tho. Any way. This breakdown has never happened to me like this. Months later I’m still struggling…the 4 sang months I was out in my bed or zombie in the house I don’t really remember..ive Ben telling my family u need to do your share. They where doing a few things maybe. Being kids too. And with no help for all these years. But they where trying so was my boyfriend their father of 19 yrs.. It hurts it makes u realize like this article says this illness is selfish..just look in your family’s eyes to see how you are doing..if not we’ll ask them if you guys could have a time to talk about because sometimes it’s not you that runs off and acts crazy.. Crazy runs up on u.
Dear Julie and All,
Every article gives me tips on how to get through my ups and downs with progress not “bp ,perfection”.
Not feeling alone strengthens my willingness to learn “what I need to take care of myself”.
I still need daily reminders to “hold my head high” and enjoy life, while I learn to improve my relationship with myself others.
Medically reviewed by Aaron Wiegmann, MD
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What is bipolar insomnia? How are bipolar disorder and insomnia connected?
Sleep disturbance is a significant feature of bipolar disorder, and is one of several criteria used for diagnosis, as it is a frequent symptom of both mania and depression.
During manic episodes it’s common to feel a decreased need for sleep, or suffer from insomnia; however, these are distinct entities.
But insomnia, and the associated sleep loss inherent to bipolar disorder aren’t just symptoms of mania; reduced sleep can also trigger manic episodes and is a good predictor of the onset of mania.
The depressed phase of bipolar is characterized by hypersomnia, where a person sleeps for extended periods or naps frequently throughout the day. This irregularity in sleeping patterns then tends to increase the risk of new episodes of mania or depression.
Interestingly, research has found that disrupted sleep patterns are common in people with bipolar disorder even between bipolar episodes.
For reasons not yet understood, people with bipolar disorder have more delicate body clocks. 4 (bipolar disorder with mixed features showed a greater severity of insomnia and chronobiological rhythm de-synchronization)
The treatment of sleep disturbances and maintaining a regular sleep/wake cycle are important components in the prevention of mood episodes in bipolar disorder.
Circadian rhythms, bipolar and sleep
A circadian rhythm is approximately a 24-hour cycle in our biochemical, physiological and behavioral processes.
Not sleeping but still feel energized? This is a classic sign of bipolar mania.
Our circadian rhythms govern sleep, hormonal function, appetite, and body temperature.
Scientific research suggests that the Clock gene, which regulates the body’s circadian rhythms, may be involved in the development of bipolar disorder.
5 (CLOCK genotype associated with worse insomnia)
People with bipolar disorder generally have irregularities in their circadian functions, including the body clock and its sleep/wake cycle.
Exhaustion, sleeplessness and disruptions to sleep patterns can trigger a bipolar episode.
6 (strategies for sleep to avoid mood disruption)
Establishing and maintaining a regular sleep/wake schedule, as well as stabilizing the circadian rhythm, are the primary elements of a relatively new treatment for bipolar disorder.
Some scientists believe that the increase of bipolar disorder in modern times is caused by the widespread use of artificial light. Before artificial light people’s sleep/wake cycles were regulated by the sun; it is possible that people who are genetically predisposed to bipolar disorder may develop the condition without the overall patterns of dark and light changing slowly and naturally.
Regular sleep helps bipolar
Sleep is an essential part of good health in all people and is vital to our well-being. Insufficient sleep causes significant health problems such as increased stress on the immune system, anxiety, depression, and increased risk for gastrointestinal and cardiovascular disease.
Deep restful sleep is of particular importance to manic depressives, as bipolar disorder can impair judgment and lack of sleep can exacerbate this.
Daytime mood regulation and night-time sleep form a two-way relationship; once rhythms are disturbed such as with bipolar insomnia, a self-perpetuating cycle can begin where moods interfere with sleep and then disrupted sleep affects mood regulation the following day.
It is recommended that people suffering from bipolar insomnia and hypersomnia sleep between 7-9 hours a night, go to bed at the same time each night, and get up at the same time each morning.
Regular schedules and sleep patterns have a positive affect on bipolar treatment and it is advised that activities that disturb normal routines be avoided. Re-establishing and maintaining a regular sleep, meal and activity schedule is one of the reasons why a stay in a bipolar treatment center can be so helpful.
Bipolar sleep tips
Some tips for establishing healthy sleep patterns to combat bipolar insomnia are:
1. Determine your need for sleep and meet it nightly.
2. Go to bed at the same time and get up at the same time.
3. Create a bed-time routine.
4. Limit napping to one short, early afternoon nap.
5. Use sleep as an aid to deal with oncoming mood episodes that are foreshadowed by prodromal signs.
6. Use a journal to record any thoughts that might be keeping you awake.
7. Try relaxation tapes and techniques.
8. Exercise regularly.
9. Avoid caffeine.
10. Avoid alcohol.
11. Follow The Bipolar Diet to manage swings in blood sugar and mood, and improve overall stress levels.
In this Article
In this Article
In this Article
- Warning Signs
- Reducing Risk
If your doctor has diagnosed you with bipolar disorder, you know what a manic episode feels like. To be diagnosed, you must have had at least one episode of mania or its milder form, hypomania.
During these stretches, you may feel fabulous, with lots of energy and an “up” mood. But those feelings are a symptom of mental illness. So itвЂ™s important to recognize the early signs that mania is developing.
Just because youвЂ™re extra-energetic and in a good mood doesnвЂ™t mean youвЂ™re starting a manic episode. But be aware of patterns, such as when:
- You feel youвЂ™re on top of your life even if itвЂ™s not really going well.
- You have anxiety that canвЂ™t be explained by a stressful event, such as an upcoming exam.
- Your thoughts race and you’re irritable.
- You’re sleeping less and not taking good care of yourself.
- You talk too much or faster than usual.
- Your sex drive is revved up.
- You turn more often to alcohol or drugs or do other risky things like drive dangerously.
Once you’re in a full-blown manic state, you may not think you need help or be willing to accept it. That’s why the best way to deal with mania is to address it early on.
If you think you’re heading into a manic stretch, first get in touch with your doctor. They may need to change your medication dose or recommend that you try another one.
Take your medicine exactly as your doctor prescribes, even if you donвЂ™t think you need it. Tell your doctor about any supplements or herbs youвЂ™re taking. They may cause worrisome side effects.
Other things that may help:
- Review what’s happening in your life and your stress level. See if you can dial back your commitments a bit. If you slow down now, you may avoid having to take more time off later because your symptoms got worse.
- See a counselor or therapist. If you arenвЂ™t already in therapy, find someone who treats people with bipolar disorder. They can help you learn ways to identify and cope with troubling thoughts, emotions, or behavior.
- Look for ways to relax. When you talk with others, focus on listening. Carve out time to read, listen to your favorite music, or watch a show.
- Get enough sleep. This is not a time to skimp on your ZZZs. You need at least 6 hours a night.
- Watch out for caffeine. Steer clear not only of caffeine in beverages, like sodas and energy drinks, but in over-the-counter medications.
- Stay away from drugs and alcohol. They can affect your mood and may interact with medications youвЂ™re taking.
- Above all, donвЂ™t postpone seeking help so you can continue to ride the manic вЂњhigh.вЂќ The higher your manic episode rises, the further your mood may tumble after it ends.
Talk to your doctor or therapist about what you should do when you’re already in a manic state. And plan ahead. You might ask trusted friends or relatives to call your doctor if they notice signs of mania.
Here are some practical ways to protect yourself while you’re in a manic episode:
- Keep up your normal routine. As much as possible, try to maintain a stable daily schedule. This includes your sleep, eating, and exercise patterns.
- Guard your finances: Limit how much cash you carry. Consider temporarily giving your credit cards to someone you trust to avoid impulse purchases.
- Delay big decisions. Don’t make any major changes before you talk to someone, such as a mental health clinician or a relative. At the least, give yourself time to reflect before you take action.
- Bypass risky situations. This isnвЂ™t the right time to begin a new relationship or sort through a conflict with a friend.
Once you feel better, keep up your healthy habits. That includes exercise, which can improve both mood and sleep. Build up your toolbox of strategies to reduce the intensity of future episodes:
- Look at what boosts your stress level. Lots of aspects of your life, whether itвЂ™s your job or a person you deal with, may affect your mood.
- Think about what may have been early signs of previous episodes. Was missing sleep for a few nights an early signal? Tell loved ones about those signs so they can watch out for them, too.
- Track your mood each day. When you keep a daily mood diary, you and your doctor or therapist can look for patterns. How do medication, sleep patterns, and life events affect how you feel?
- Once your mood is stable, reflect on how mania affects you in good and bad ways. Write down those thoughts. Then you can remind yourself of the downside when you’re tempted to ignore the early signs of mania.
Mood Disorders Association of British Columbia: вЂњBipolar Disorder: What can I do to prevent future manic episodes?вЂќ
National Alliance on Mental Illness: вЂњBipolar Disorder.вЂќ
National Institute of Mental Health: вЂњBipolar Disorder.вЂќ
SANE Australia: вЂњSelf-care for managing mania.вЂќ
International Bipolar Association: “11 Ways to Support Someone During Mania.”
Anyone with bipolar disorder knows that sleep is a problem. In fact, sleep disturbance is reported during episodes of mania and depression over 90% of the time.
For people like me who rapid-cycle, insomnia occurs during episodes always. 100% of the time according to a study from UC Berkley.
Sleep disturbance is the most common predictor of an oncoming episode. While insomnia hits us with obvious distress, the real culprit may be sleep latency.
Sleep latency is the length of time it takes to progress from full-awake to sleep. Longer latency can reduce REM sleep and precipitate mania and/or depression. But when latency lengthens, you may not want to get up and move around.
The study details how researchers have used darkness therapy to stop manic episodes. People in manic episodes were put to bed in dark rooms for fourteen hours for three nights. Rarely did they sleep most, or even much of the time. But after three nights spent this way most subjects’ episodes of mania stopped.
Sleep disturbance can make moods swing both ways. In people with bipolar disorder experiencing depression, one missed night of sleep, defined as being awake for 40 hours, led to 7 out of 9 people shifting into a manic or hypomanic episode.
The message is to get a good night’s sleep. But that’s not an easy thing to do, and on top of the influence of sleep on mood, and mood on sleep, there’s the complicating factor of medication.
As the researchers concede, it’s difficult to attribute the pure influence of sleep disturbance since medication itself can make sleep patterns difficult to monitor. The subjects of the study took a variety of psych meds. The researchers were unwilling to add a study group without meds since removing people from meds for the length of the study was decided to be too dangerous.
Interestingly though, the researchers did look at lifestyle issues like obesity and smoking that are commonly co-morbid with bipolar disorder and are greatly influenced by or on sleep.
Most people with bipolar disorder are overweight, and over 30% are obese. Obesity is much more common in people who get fewer than 5 hours of sleep a night. Again we face issues of causation vs correlation, as it’s unclear whether the lack of sleep contributes to the weight gain or if the extra weight, through problems like sleep apnea, contributes to the lack of sleep.
The influence of smoking on sleep is more clear cut. More people with bipolar disorder smoke (60%) than people in any other measurable category. Smoking significantly increases sleep latency, which makes mood swings much more likely. Sleep latency caused by smoking is also noted as a predictor of poor impulse control, which can be deadly during manic, depressive or mixed episodes.
For many people with bipolar disorder the best remedy for sleep disturbance is to quit smoking.
It’s ironic that I’m writing this at 3:00am. I fell asleep fine, but I woke up in the middle of the night and can’t find my way back to bed. According to the study, tomorrow I’m likely to be irritable and confrontational. I’m afraid the people who live with me will agree.