Why Structure Is Everything With Bipolar Disorder

by Matt McMillen Health Writer

If you have bipolar disorder, a set routine for your day—every day—can be a lifeline. This condition is marked by extreme mood swings, so in times of stress, isolation, or uncertainty, your mood can be destabilized. “People with bipolar disorder are especially sensitive to the disruption of routines, and we don’t know exactly why that is,” says Timothy Sullivan, M.D., chair of psychiatry and behavioral sciences at Staten Island University Hospital in New York City. Experts do know that a routine can buffer you from worry and anxiety. Here’s how to do it.

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Routine and Physiology

“Routine refers to a regimented lifestyle that needs a mixture of both work and rewards,” says UCLA professor of psychiatry David Miklowitz, Ph.D., author of The Bipolar Disorder Survival Guide. The regimented part is key if you have bipolar. A set schedule means you rise and shine at the same time each day—which helps prevent disruptions to the brain’s regulating system for sleeping and waking. Such disruptions can trigger an episode of mania that makes you feel euphoric and full of boundless energy or lead you into depression.

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Routine Supports Your Body Clock

Inside your brain, you have a clock, or pacemaker, that sets your body’s daily schedule, called the circadian rhythm. It governs sleep and other critical biological processes, like hormone production. It runs on a 24-hour cycle. A malfunctioning body clock is a prime suspect in the causes of the dramatic mood shifts that define bipolar disorder, according to research published in Current Psychiatry Reports. But, the authors point out, you can use your daily activities, including sleep, meals, and work, to train your body clock to keep ticking along as it should.

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Routine Helps You Gain Control

Bipolar disorder can leave you feeling helpless as your mood shifts from one extreme to another. But a routine can help you counter that feeling. By stabilizing your daily schedule, you reduce some of the uncertainty that causes the pendulum swings in your mood, says Miklowitz. It won’t be perfect. After all, life happens, and things will disrupt your routine from time to time. But, as Dr. Sullivan says, when that happens you will already have a foundation established, one that allows you to return to what works—and regain control.

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Routine Keeps You Focused

Rumination is hallmark symptom of depression in bipolar disorder. You get a negative thought stuck in your head, and you return to it again and again. They’re often self-recriminating thoughts filled with guilt or shame and feelings of worthlessness. But thought loops like this can also occur when you’re manic. How can your routine help? Established activities, done on schedule, give you something else to focus on, whether it’s completing a work project that will occupy your morning, getting the evening meal ready, or completing chores and errands. All can serve as diversions that halt rumination.

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Routine Can Help You Relax

“Some people with bipolar disorder have a lot of trouble making time for leisure activities or their social lives,” says Dr. Sullivan. “But there’s good science to support that it’s important.” Your routine should include fun and rewarding activities, like dipping into a new novel, snapping photographs, or other diverting hobbies. Dr. Sullivan recommends that you include a variety of things to fill your leisure time—a challenge if you’re not used to “me time” being a priority. Ask your therapist for help. “Talk through the things that you find relaxing and restful,” he suggests. Then work them into your routine.

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Routine Can Keep You Connected

In an Australian study, researchers reported that people with bipolar disorder who kept in touch with their loved ones were more likely to recover from episodes of depression or mania. So it’s critical to make room in your routine to maintain relationships. That’s not always easy, especially when you’re feeling low. “When stressed or depressed, people with bipolar disorder become uncomfortable doing things that might actually be helpful but are more difficult because of their mental state,” says Dr. Sullivan. A routine can help you stick to social plans.

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How to Jumpstart Your Routine

Schedule work hours, mealtimes, exercise, errands, and chores for specific times, Miklowitz recommends. And don’t forget the small essentials: brushing your teeth, showering, walking the dog. Mark down in bold your medication schedule. Don’t overload your to-do list, especially at first. “You can’t be introducing a whole bunch of things at the same time,” he adds. Dr. Sullivan agrees: “Think about the healthy changes you want to make in your diet and which will be easiest. That way you can incorporate some and feel you are making real progress.”

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Write Down Your Routine

Dr. Sullivan recommends that people with bipolar disorder start an activity log. Document with detail exactly how you spend your day. As you fill it out with work and other responsibilities, look for holes in your schedule to devote just for you. “You may find that you don’t have much leisure activity in your day,” he says. “So, ask yourself: What do I enjoy? What are things I would put in my day if I had the time?” Then, write it down! Remember, filling your time helps you evade pitfalls like rumination.

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How to Find a Work Routine Right Now

From commuting time to office meetings, work traditionally is the crux of your daily routine. With so many of us working from home right now, it's tough to find that rhythm. Try setting up your home workspace similarly to your office; schedule Zoom calls as if they were in-person events; and use your former commute time to walk briskly around your neighborhood before settling in at the computer. The more you can mimic the expected rhythms of life pre-COVID, that better it will be for your mood swings.

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Set Your Routine, Then Stick to It

Once you put something onto your schedule, it’s crucial that you adhere to those expectations, says Dr. Sullivan. So, if you’ve penciled in an hour to read the newspaper, keep focused on that activity the entire time—and do your best to avoid distractions. “If it’s on your calendar, be responsible to what you’ve set yourself to do,” Dr. Sullivan advises. Again, be sure to mix it up with variety, even for scheduled leisure time. “Reading is great, but people can’t read all day long,” says Miklowitz.

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Chart Your Mood and Activities

Both Dr. Sullivan and Miklowitz recommend that people with bipolar disorder record their mood and activities each day to determine what helps and hinders them. For example, your log might reveal your mood was stable on days you exercised. That shows that what you’re doing for yourself has real benefits: “It gives hope and the sense that you’re not helpless in the face of whatever you’re feeling, that there are things you can do to modify your mood and mental state,” says Dr. Sullivan. Use pencil and paper or try a mood tracking app like iMoodJournal.

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Pay Attention to What’s Around You

Little things that you may not easily notice can throw you off your routine. Dr. Sullivan advises people with bipolar disorder to keep an eye open for what he calls environmental cues. “There are things in our environment that we don’t notice that can get in the way of making and maintaining changes,” he says. If you know you’re better off without alcohol—about a third of people with bipolar disorder struggle with alcoholism—be aware of any lures you need to avoid. If your routine bike ride takes you by a tempting bar, for example, change your route.

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Ask for Help When You Need It

Even the most well-established routine can’t protect against every type of stress that you may experience. You could be doing everything right, then out of the blue, your boss changes your work schedule. That might drastically upset the routine that’s helped you maintain your stability. What do you do? Call your therapist, says Miklowitz. Your therapist can both listen and guide you as you adjust your routine. Also, enlist your spouse’s or partner’s aid in keeping on track. Ask for a gentle nudge near bedtime, for example, to get you on your way to sleep.

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Be Kind to Yourself

No matter what throws you off your routine—and eventually something will—accept what has happened, make adjustments when necessary, then get right back into your modified routine without being hard on yourself. “You have to have rules for yourself but you also have to be self-forgiving, have compassion for yourself,” says Miklowitz. Have you eaten a piece of cake or half a pint of ice cream when your routine called for a healthier meal? “It doesn’t mean the world is ending,” says Miklowitz. “Don’t punish yourself.”

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.