Despite having lived with bipolar disorder for over twenty years, it wasn't until my current psychiatrist and psychologist incorporated regular dialogues about sleep that I finally tuned in. My psychologist reminded me at many appointments that sleep was the other half of my medication.
And it finally stuck.
Though when I thought back to all the mental health professionals over the years, I wondered why this knowledge wasn't ingrained in me sooner. Surely, they must have brought this up. Was I not listening? Or, had emphasis not been placed on it back then? According to PubMed a.k.a. NCBI, the U.S. National Center for Biotechnology Information, mania and sleep were linked. Still, those were only part of the equation, there were also circadian rhythms, our twenty-four hour clocks, to contend with.
One study showed bright light and sleep restriction acted as an antidepressant and sometimes triggered mania. WebMD stated that for three out of four people with bipolar disorder sleep problems were the most common signal a period of mania was about to occur. This is why being aware of our sleep patterns is of paramount importance though often our loved ones see it first.
After reading a fast-forward research article by Dr. Ellen Frank PhD, I tracked her down for more insight. Dr. Frank is the author of Interpersonal Psychotherapy, a distinguished Professor of Psychiatry and Professor of Psychology at the University of Pittsburgh School of Medicine, Western Psychiatric Institute and a member of the Pittsburgh Mind-Body Center. She shared this:
Both our clinical experience and our research studies into the effects of life events on the course of bipolar disorder show the fundamental importance of sleep in maintaining wellness. Staying up all night to study for an exam or to finish a project may be perfectly safe for someone who does not have bipolar disorder, but it is extremely risky for someone who does. Likewise, people who don't have bipolar disorder may be able to manage rotating shift work without much in the way of consequences. For someone with bipolar disorder it's poison....like asking someone with lung disease to take a job removing asbestos.
Countless times in my early twenties I proved this to be true though unaware at that time. I was young and sleep was the last thing on my mind. One of the careers that enticed me was a flight attendant, though instinctively I knew it would not end well. Apparently, jet lag can kick off a hypomanic or manic episode.
Dr. Frank continued, "It seems that individuals who have bipolar disorder are just much more sensitive to any kind of challenge to their circadian system - the change to daylight savings time or jet lag, for example, and have much more difficulty resetting the body's clock when it's been challenged. That's why it's crucial for their sleep to be regular, at the same time each night and consistent."
Interested in circadian rhythms, I sought out private psychiatrist Dr. Robert C. Bransfield, MD, DFAPA, PC in Middletown, NJ.
Dr. Bransfield said, "Greater amounts of light during the spring and early summer, working on computers at night, large screen TV sets and household lighting increase the light exposure to our retina and disrupts the circadian rhythm. Improving sleep can reduce the risk of a manic episode."
This only drove home the importance of sleep, but it has been difficult, especially in times of hypomania. With each passing year though I became more vigilant , after all the dreaded "episode zone" and hospital are two places I have not enjoyed visiting.
These are some of my sleep wellness tips.
Wendy's Sleep Tips:
- Try for 8-9 hours a night.The longer, the better especially if you are manic.
- Turn off cell phone ringer. I do use mine for alarms, but keep it silent for calls.
- Read rather than watch TV to fall asleep.This helps me fall asleep faster and avoids the bad habit of watching TV in the bedroom.
- Sleep with white or background noise. Besides the fantastic white noise machines that I swear by (on-line around $50.00) they also have free white noise apps. Air-conditioners and fans work like a charm too.
- Maintain consistent daily routine and sleep schedules. Aim to sleep the same hours each night, and keep your schedule steady. Although this is a struggle during times of hypomania, keep at it.
- Get the temperature right. If you're too hot or too cold, you will likely flip around or have to get up to adjust the temperature.
- Take seasonal precautions, when necessary. During times of the year such as change of seasons, fall and spring especially, my doctor changes one medication to help me sleep. If this is your pattern, make an appointment early.
- Keep pets out of your bed. Of course we love them but it's not okay if Fido or Tigger interrupt our sleep. I constantly ask myself, is it more important that my cat is happy and comfortable or that I am healthy? Resist the urge, I know it's hard.
Remember, sleep is the other half of our medication. We are not talking counting sheep and sweet dreams, this is about our mood stabilization and staying out of the hospital. Remove any obstacles or distractions and make a pact to prioritize your wellness.
*For more tips, check out Wendy's best-selling book: Two Bipolar Chicks Guide to Survival: Tips for Living with Bipolar Disorder.