Managing Your Bipolar, Managing Your Sleep - A Patient Shares His Insights
Gabe Howard is the second-place winner in HealthCentral’s recent Live Bold/Live Now contest. Gabe is no stranger to the challenges of living with bipolar. The wisdom and insights he has gained have led to busy speaking and writing schedule.
Recently, I had the chance to talk with Gabe by phone. We quickly zeroed in on the things we all need to do to stay well. In the course of our conversation, Gabe kept stressing the importance of good sleep.
I decided to follow up with some email questions. Here are Gabe’s responses ...
First Question: Why the heavy emphasis on sleep?
Americans, for reasons I don't quite understand, associate sleeping with laziness. Sleeping is a biological necessity and you can't just "choose" to do it.
Sleep hygiene is very important for everyone, but it is especially important in people who have difficulty sleeping.
How is your home set up to promote good sleep?
In order to send a clear message to my body that it is time to sleep I set up my bedroom in the following way:
- I only use my bed for sleep and sex. (I do not read, use the internet, etc, in bed.)
- I do not have a TV in my bedroom.
- I keep the temperature in my room cooler than the rest of the house.
- I keep my bedroom very dark.
- I spend the extra money on a good mattress, extra pillows, and quality linens and blankets.
For me, the bed being made or unmade is not important - although my wife makes the bed and I have gotten used to it.
What is the importance of keeping your bedroom cooler?
This is a personal preference, but it also sends a signal to your body that it is time to sleep. Your body picks up on all these little signs - temperature change, sleeping clothes, silence, darkness, lying down - as indicators that it is time to sleep.
Do you wind down at night? Any routines?
I am not a person who can just jump straight from something energetic and go to sleep. I need some down time. I spend 30-60 minutes watching television or doing something mindless. My goal is to settle my mind so that I can calm down enough to sleep.
Thirty to 60 minutes before I go to bed I take my medication.
Once I am in bed I do have routines as well. I get comfortable and I do my best to slow my mind.
Do you try to maintain a sleep-wake schedule?
I try. I do have insomnia so I'll go months where I do really well (I try to go to bed at midnight and wake up at 8) and I'll have weeks where I don't sleep more than 3-4 hours at a time (or really bad nights where I don't sleep at all). I do try, yes. But I am not always successful. But I believe it is important to do two things:
1. Try to have a good sleep-wake schedule
2. Not beat myself up when I fail. I have an illness working against me - the best I can do is sometimes all I can control.
When something upsetting happens that you know will wreck your sleep, what do you do?
Anxiety/panic attacks are really a factor. I have a medicine I can take to calm down, on a take-as-needed basis. That slows down my mind and allows me to focus on sleep.
But, sometimes there is nothing I can do. Managing symptoms doesn't mean I always win. Sometimes mental illness kicks my ass and leaves me up all night. That is just life, I guess.
Another issue tied into sleep is managing stress. If we're stressed or our mind is racing, we're not going to sleep. What do you do?
Calming my mind is hard. I do successfully fall asleep more than I don't, but sometimes I lose that battle.
Another hazard is staying up all night to work on a great idea we have. How do you tear yourself away from the project?
Having a set routine really does help with this. I say to myself, "It is midnight, it is time to stop." I am not saying I've never stayed up all night, but, as I've gotten older, the urge to do so has passed. But every now and again I do it.
When your sleep is thrown off, what do you do?
I suffer. I try not to “reverse my sleep cycle.” In other words sleep all day because I was up all night. Sometimes I'll take a nap, but I try to limit it so I don't end up staying up all night. It isn't the easiest thing, but living with chronic mental illness isn't easy. I do the best I can.
What are your views on taking naps?
If you need sleep, you need sleep. I will say that sometimes you just need to take one. Other times, it makes more sense to wait a couple hours and go to bed a little early (so as not to flip your sleep schedule around). I find that setting an alarm and sleeping for an hour is better than a long nap.
What are your views on caffeine?
For most people, caffeine will impact sleep and shouldn't be taken at all, or not past a certain time. Caffeine has no effect on me at all. I had zero caffeine for one year and had identical issues with sleep. I can drink a venti Starbucks latte and fall right asleep. But I am an outlier - this is atypical.
Are there any other things about sleep that our readers need to know?
People need to understand that sleep is very personal. Just because one person only needs six hours sleep and another person needs 10 hours sleep doesn't mean the 10-hour person is lazy. We need to stop judging sleep. We need sleep to be a healthy part of a good life. It is important to get enough sleep.
I have sleep apnea. I sleep with a CPAP machine, and at first it was annoying. But I have used it for 10 years and I am very used to it. Don't cheat yourself out of quality of life because you think sleeping is bad or wasteful. It is not - it is needed for survival and for wellness. People who get enough sleep lead better, healthier, more stable lives.
Don't be afraid to see a sleep doctor if you think something is wrong. If you walked with a limp you'd see a doctor -- same with sleep. Think there is a problem? Get it checked out!
Pease check out more of Gabe's insight and wisdom on his website and blog, Gabe Howard.
Also read his piece on HealthCentral, My Path From Bipolar Patient to Mental Health Activist.
Plus his second-place entry in Live Bold/Live Now.