9 Tips to Help Sleep With Bipolarby Julie A. Fast Patient Advocate
Bipolar disorder responds well to a sleep plan that respects the body’s circadian rhythm. Learning to prevent mood swings by making good “sleep hygiene” choices is an inexpensive and natural way to prevent mania and depression. Sleep changes are not always easy in our very busy world, but please know that making even a few of the changes discussed here can reduce the need for certain medications and ultimately prevent mood swings.
Decide if you’re serious about improving your sleep or if you just like talking about it.
Only when you’re willing to sacrifice in order to sleep will you see big changes. This isn’t fun and it’s not fair, but focusing on getting enough sleep at the same time every night can be life changing when you have bipolar. This is especially true for people who have rapid cycling, defined as more than four mood swings a year.
Determine the source of your sleep issues.
Although bipolar is notorious for causing sleep problems, not all sleep issues are bipolar created. If possible, get an overnight sleep study and see if you have a physical cause for sleep issues. Being overweight (something I deal with), hormonal changes especially with menopause in women, changes in testosterone related to aging in men, and physical pain can all cause significant changes in sleep.
Understand the connection between sleep and bipolar.
Bipolar acts like a sleep disorder. Think of the way your sleep changes when you get manic, or how depression can make you wake up too early and then flood you with too much thinking or make you so tired you feel like your body is attached to bricks. It makes sense that managing sleep is the best way to manage bipolar. My nurse practitioner, Julie Foster of Pohala Clinic in Portland, OR, always says, “Regulated sleep is nature’s best medicine.”
Study melatonin, serotonin, and your body's clock.
The body has a 24-hour clock regulated by the afternoon release of the hormone melatonin and the morning surge of the neurotransmitter serotonin. Dr. John Preston, coauthor of Take Charge of Bipolar Disorder, suggests a .5 mg dose of melatonin 30 minutes to an hour before sleeping. Serotonin is related to mania. Using a light box in the morning (this increases serotonin) or taking selective serotonin reuptake inhibitors (SSRIs) without mood swing prevention is discouraged in bipolar.
Respect your inner clock and go to bed on the same day that you woke up.
This is the concept behind circadian rhythm sleeping. Think of being asleep by 11 p.m. and waking up at 7 a.m. as your guideline. No, this isn’t easy and in many instances, it will require saying no to something you might really want to do. However, try this for a month just to test the results.
Check all supplements and over-the-counter drugs to see if they affect sleep negatively.
It’s quite shocking to see sleep aids that contain substances such as 5HTP (a serotonin precursor supplement that can create mania) in over-the-counter sleep aids. All of us with bipolar must check “natural” sleep aids for anything that can make our sleep worse. For example, I have nightmares from valerian. Your bipolar brain doesn’t process substances in the same way as a “normal” brain.
Get real about caffeine.
We often lack energy due to bipolar depression. Energy drinks do work at first and can lift our mood when we are down. Caffeine is a stimulant. It affects sleep. If you’re a person with restlessness due to bipolar, too much caffeine can make things worse. Dr. Preston suggests that 250 mg of caffeine before 2 p.m. is about all we can handle if we have sleep problems. And if we still can’t sleep, it’s time to switch to decaf, herbal tea, and stop all energy drinks.
Avoid all shift work, night work, and work that has a changing schedule.
Most people have to make a living, and you can’t always be in control of your schedule, but please know that studies on sleep and bipolar often come to the same conclusion: shift work, working at night, and sleeping during the day and/or a changing schedule is not healthy for people with bipolar. Dr. Preston lists these sleep situations are second only to drug and alcohol abuse as the biggest bipolar triggers.
Study cannabis carefully before using it for sleep.
Hallucinogenic cannabinoids or tetrahydrocannabinol (THC) can be highly stimulating for people with bipolar, and it is connected to an increased risk for psychosis. Avoiding THC is smart when you need to sleep. Pure cannabidiol (CBD) is a possibility; however, for many people with bipolar, it calms the body, but activates the mind. My brain is like a racehorse when I use any kind of cannabis.
Getting your sleep in order when you have bipolar will not be easy, but please know that sleep management is the number one way a person with bipolar can naturally, and at very little cost, take care of many of the ups and downs associated with the illness. Respecting our circadian clock is smart medicine.