Stress, Sleep, and Mindfulness: My Bipolar Recovery "Big Three"

Patient Expert

Warning: Nothing new, here. Think of the following as sort of a review lesson ...

The other day, I found myself elaborating on my own "recovery big three" to an acquaintance. This had to do with managing stress, managing sleep, and cultivating mindfulness. I have written extensively on these topics, either separately or in wider contexts, but never - to the best of my recollection - together.

What I found myself saying to this person was that if we don't get some kind of handle on the big three, we are going to find our illness very difficult to manage.

Okay, that sounds important enough to write about.

Let's start with stress ...

Walk into any DBSA group and you will come across living reminders of how stress triggers mood episodes. At these groups, you will pick up a hundred useful tips in staying clear of these triggering events.

This practical wisdom is supported by no end of scientific research demonstrating the links between our genes and our environment. Each influences the other. Think of bipolar as our occasional inability to cope with whatever life chooses to throw at us.

We get stressed, bipolar happens. This is a gross oversimplification. Nevertheless, it is a far better way to approach our illness than by thinking in terms of that other gross oversimplification - chemical imbalance.

Chemical imbalance implies an over-reliance on our doctors to balance our chemicals for us. By contrast, managing our stress puts us in the driver's seat (even if it may happen to involve meds). Learn to handle stress, and a lot of our bipolar takes care of itself.

Fine. I think we all get that. (Stress article here.)

That brings us to sleep ...

Try finding someone with a bipolar diagnosis who has not had a sleep problem. So linked is sleep to bipolar that at times I'm convinced that sleep dysfunction is the real illness and bipolar is the downstream effect.

This view was unexpectedly validated for me in a conversation I had a number of years ago with Frederick Goodwin, former head of the NIMH and co-author of Manic-Depressive Illness.

Mind you, Dr Goodwin was talking to me in the context of a personal observation. Nevertheless, we do have numerous studies showing, among other things, a strong link between lack of sleep and mania.

On a personal level, my worst over-the-top behavior has been preceded by lack of sleep. One of those episodes resulted in the loss of a livelihood.

Very clear message: Do whatever you can to get on a regular sleep schedule and make this a priority in your life. Again, I think we all get that. (Sleep article here.)

Then there is bipolar ...

I have asked you to conceptualize bipolar both as a stress-related and a sleep-related illness. A third way of looking at bipolar is as a cycling illness. This is the classic mood disorder we are all familiar with. We cycle up, we cycle down.

But it's not just that our cycles are more pronounced than whatever passes for normal. Our cycles are also extremely sensitive to changes in the environment. And when stress meets messed-up sleep meets cycle, bad things tend to happen. (Cycling article here.)

The stress-sleep-cycle perfect storm ...

Perhaps this has happened to you: A miscommunication brings on the kind of worry that propels your mind into a state of overdrive. Racing thoughts, the works. Stress meets cycle. Not good.

Oh, and how do you expect to slow down your brain enough so you can get to sleep that night? And not having slept, how do you expect to cope with life the next day? Especially with a brain that's cycling like crazy.

Enter mindfulness ...

Mindfulness is basically the mind watching the mind. It's as if we are dispassionate observers to all that goes on in the brain - our thoughts, our feelings, our moods, our energy levels. Even if we are in an advanced state of blowing up or shutting down, there is a part of us that is observing the process.

Think of mindfulness as the brain's ultimate killer app. With practice, we can literally see trouble coming, the earlier the better. The solution could be as simple as stopping to smell the roses.

But even at the other extreme - those "in-case-of-emergency-break-glass" situations - we are not entirely powerless. Here, mindfulness may at least give us the presence of mind to look out for our physical safety or reach out for help. (Mindfulness article here.)

How mindfulness fits into the equation ...

Nothing will throw off a cycle faster than a stressful situation or messed up sleep. The interventions are numerous, but first we have to see it coming. Mindfulness is no guarantee, particularly when life either takes us by surprise or becomes too much to bear, but it is the best tool we have going for us.

Accordingly, it is no surprise that cognitive-behavioral therapy and dialectical behavior therapy both heavily rely on mindfulness techniques. Likewise, a new generation of bio-feedback tools (see article) are based on enhancing our capacity to watch what is going on in our heads.

Cultivate your mindfulness skills. This will make managing your stress and your sleep a lot easier. Your cycles will thank you. Be aware, live well ...