Ask the Doctor: The Link Between Insomnia, Bipolar, and Emotions

With bipolar disorder, mood and sleep affect each other — either exacerbating manic or depressive symptoms or mollifying or preventing them altogether.

Is It True Sleep Plays a Major Role in Bipolar Disorder?

Sleep is an essential clue to what is going on with bipolar disorder, and mood and sleep affect each other. Poor sleep can intensify difficulties with mood, and mood can affect our ability to sleep. In mania or hypomania, sleep is decreased and energy is increased. In depression, sleep may be increased or decreased, and energy is lacking. Practicing good sleep hygiene has a huge impact in managing bipolar disorder.

What Can I Do to Help Regulate My Sleep?

Because daily routines help regulate sleep cycles, it’s essential to get into a sleep routine that stays the same every day of the week — yes, even on weekends! I find that most people really balk at this suggestion, but those who work toward this goal find new levels of wellness. Scheduling your sleep and wake times is crucial for regulating mood.

So if you have to get up at 7:00 a.m. most days of the week, it’s important to get up at 7:00 a.m. every day. The common pattern of sleeping in late (or all day) on weekends can throw a monkey wrench into your wellness plan. Committing to dealing with sleep is a difficult and challenging choice to make — it will probably affect your social life, because it means late nights won’t work so well — but it also pays off in spades.

At What Point Should I Talk to My Doctor?

Talk with your doctor if your sleep pattern changes. This is an important discussion because poor sleep is both a sign and a trigger of mood instability. If your sleep is poor for three nights in a row, it’s time to give your doctor a call. Don’t wait until your next appointment if it’s more than a week away. Early intervention with sleep difficulties can prevent an episode of depression or mania/hypomania.

Improving your sleep pattern is a long-term project, so be patient and persistent with yourself as you learn to manage your sleep by working with your doctor to improve your sleep hygiene.

Tips on Falling — and Staying — Asleep

• Avoid exercising vigorously, watching stimulating TV shows, or playing intense games before bedtime.

• Plan a period of quiet time to wind down before and after you go to bed — for some, half an hour works; for others, more time is needed.

• Discover what helps you relax before you can fall asleep.

• Deep breathing, peaceful meditation, reading, quiet conversation, or a warm bath can be helpful.

Once you go to bed, stay there. For insomnia that is not related to bipolar disorder, sleep hygienists suggest getting up and going into another room to read or engage in a quiet activity until you feel sleepy, but with bipolar disorder, this will keep your mind activated and make it even more difficult to sleep. Lying still with your eyes closed is extremely difficult if you have mania or hypomania, but sleep — or at the very least, physical rest — is critically important to mental wellness.

When you first wake up in the morning, look at the sky (not the sun) for about five minutes. This will help set your internal clock. If the sun isn’t up at your wake time, consider getting a blue spectrum light therapy box and ask your doctor how to use it. If dawn’s early light wakes you up earlier than your scheduled time, use shades to keep your room dark until it’s time to get up.

Preparing Your Body for Sleep

Try relaxing your muscles beginning at your head and moving slowly to your toes. If you have trouble doing this, first tighten a muscle group — try making a fist — and then relax it. As you relax your muscles, think about your body becoming heavy and sinking into the bed.

UPDATED: Originally printed as “Ask the Doctor: Trouble Sleeping & My Emotional Stability,” Summer 2012