Coping With Life’s Uncertainties When You Have Bipolar Disorder

by Matt McMillen Health Writer

A pandemic, a fraught election, and other stressful uncertainties can disrupt anyone’s routine and wreak havoc on your sense of equilibrium. But if you have bipolar disorder, stress can have an outsized impact. “Stress can lead to worries that you go over and over again in your mind and which can leave you feeling helpless,” says Timothy Sullivan, M.D., chair of psychiatry and behavioral sciences at Staten Island University Hospital in New York City.

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What Is Bipolar Disorder?

Bipolar disorder is a mental illness marked by dramatic mood swings, from the high energy, elated feelings (mania) to the lows of severe depression. “Depression is much harder to treat than mania, and it tends to be more persistent,” says Dr. Sullivan. Stress is a major trigger for this low-mood cycle. “Along with feelings of helplessness, stress can evoke more severe symptoms of depression,” he says. Still, there’s plenty you can do to help manage stress, rather than letting it derail your efforts to take care of yourself.

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Be Sure to Exercise if You’re Bipolar

Exercise reduces the level of stress hormones circulating throughout your body, it elevates your mood, and it helps you sleep—a winning combination of benefits for anyone with bipolar disorder. “Regular daily exercise is always a good thing,” says David Miklowitz, Ph.D., a professor of psychiatry at UCLA and author of The Bipolar Disorder Survival Guide. And it doesn’t have to mean a trip to the gym (which is pretty tough to do during lockdown). “Anything that gets your body moving" helps, says Miklowitz.

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Work Out at the Right Time of Day

If you haven’t exercised in a while, go easy. Take a walk around the block, or do calisthenics in your basement. Your doctor can help set safe and specific goals. Not a morning person? Pencil in your workout for late afternoon or early evening. Just be sure to avoid intense exercise within an hour before bedtime. “We know that exercise at night tends to wake people up more than put them to sleep,” explains Miklowitz. Getting quality sleep is super important for folks who are bipolar—especially during stressful times. Why? Read on.

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If You’re Bipolar, Sleep on a Schedule

Stress makes it harder to fall asleep and stay asleep—and lost sleep makes it harder for your body to regulate stress hormones, according to the Endocrine Society. People with bipolar disorder are sensitive even to small disruptions in their sleep-wake cycles, says Miklowitz. So stick to the same sleep schedule each night. And, whether you go to bed at 11 p.m. or 1 a.m., aim for 7 to 8 hours of quality ZZZs. “Often, people with bipolar disorder sleep less during the week, then sleep-binge on the weekend,” says Miklowitz. “That has a way of throwing off your mood.”

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Ways to Improve Your Sleep

There’s lots you can do to conquer sleep problems. Miklowitz recommends that you avoid activities at night that can over-stimulate and keep you up, like late-night TV binges or internet rabbit holes. Other tips: Avoid sugar, caffeine, and alcohol close to bedtime. All can make sleep difficult. Don’t do stressful work or have stressful conversations in your bedroom, as the stress may linger when you attempt sleep. Keep your bedroom dark. Use a white noise machine or earplugs if necessary. Relax before bedtime. Miklowitz says a warm bath can help.

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Talk to a Pro for Better Sleep

If you’re bipolar and you struggle with sleep, talk to your doctor or therapist. Dr. Sullivan says you may benefit from cognitive behavioral therapy for insomnia (CBT-I), which generally involves 6 to 8 weeks of talk therapy sessions that address what’s keeping you up at night, plus learned techniques for better-quality sleep. Your therapist also can help you anticipate, and then make adjustments for, events that might disrupt sleep, like changes at work or upcoming travel, says Miklowitz, who advises that you return to a regulated sleep schedule as soon as possible once such events have ended.

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Zoom to Avoid Isolation

Connecting with others can help when you're facing uncertain times, and it may also help prevent depression in people with bipolar disorder, according to a study in BMC Psychiatry. COVID dictates social distancing, but it’s still possible to connect with friends. “It’s important you don’t give up on your social life right now,” says Dr. Sullivan. He advises starting your day with a conversation: Chat with your spouse, take a (masked) morning walk with a pal, or attend a bipolar support group. “Use Zoom when necessary,” he adds. “It’s not the best thing, but it’s the best we’ve got right now.”

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Make a Feel-Good List

When the day’s uncertainties start to bring you down, you need something that will lift your mood and relax you. But bipolar disorder can put your head in a particularly negative place, and that makes it difficult to picture something fun and engaging. Prep ahead for times like this by brainstorming a list of the many things you like to do, Miklowitz recommends. Maybe you like Marx Brothers movies, working in your garden, or making collages. “Make the list when you’re feeling well and pull it out when you feel depressed,” he suggests.

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Practice Peaceful Thinking

Calm your thought through mindfulness meditation, in which you gently push intrusive ideas out of your mind while you focus your full attention on your breathing, your body, or on a sensory experience like the scent of flowers. “People who learn to do it say it basically takes them away from whatever they’re thinking about for a little while,” Miklowitz explains. “It can take the pain out of their thoughts.” Mindfulness requires some practice, so don’t be discouraged—try and try again. If it’s not for you, that’s fine; it’s just one way to reduce stress, says Sullivan.

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Remember: No News Is Good News

It’s hard not to stay glued to your phone and other sources of news during uncertain times, but Dr. Sullivan advises that people with bipolar disorder limit how much they tune in to the day’s headlines, which "tend to be repetitive, alarmist, and sensational,” he explains. “We find that the news provokes intense states of worry, and that’s not good for your mood.” It can lead to what Dr. Sullivan calls ruminative thinking, in which you get stuck focusing on and stressing about something that’s out of your control. “That is a risk factor for depressed mood states,” he explains.

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Find Distractions

When you have bipolar disorder, you likely have experienced times when you just can’t shake a negative thought that keeps looping around your head. And the current pandemic certainly offers its share of stressful things to fixate on. But you can break that loop. Turn on some music, call a friend, do yoga. “Even something as basic as splashing cold water on your face can distract you from the stressful things you may be thinking about,” Miklowitz says. “I’m a big fan of distractions, of things that stop your mind from going in circles.”

Matt McMillen
Meet Our Writer
Matt McMillen

Matt McMillen has been a freelance health reporter since 2002. In that time he’s written about everything from acupuncture to the Zika virus. He covers breaking medical news and the latest medical studies, profiles celebrities, and crafts easy to digest overviews of medical conditions. His work has appeared, both online and in print, in The Washington Post, WebMD Magazine, Diabetes Forecast, AARP, and elsewhere.