Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability
By Julie A. Fast, John Preston, Psy.D.
Depression and mania are notorious sleep disrupters. If you're already in a mood swing, it can be hard to tell the chicken from the egg. Depression can cause sleep disruption in three ways. The first is hypersomnia, or sleeping too much. Hypersomnia paradoxically often leads to extreme daytime fatigue. The second problem is insomnia. There are two common varieties of insomnia seen in depression: middle insomnia (tossing and turning and waking up numerous times during the night) and early-morning awakening (waking several hours before you want to get up and being unable to fall back to sleep). The third problem is a reduction in the amount of time spent in deep sleep, often due to caffeine, alcohol, and tranquilizers such as Xanax, Valium, Klonopin, Ativan, and others. Deprived of adequate deep sleep, people tend to feel very fatigued during the day and often start consuming more caffeine or using more tranquilizers or alcohol to sleep, when these are the very substances that can cause the sleep disturbance in the first place.
Anxiety is also a very common experience for those suffering from bipolar disorder. It often causes difficulty in falling to sleep-something professionals refer to as initial insomnia.
Mania affects sleep in an opposite way. Mania and hypomania are always accompanied by a markedly decreased need for sleep, but without fatigue the following day. If you begin to notice that you're stalling to sleep a few hours less than normal at night (four or five hours a night, for example) and still feel full of energy when you wake up, this is a serious sign that mania may be starting, and you need to talk with your doctor immediately. Even though it probably feels great and you love having the energy, these good feelings rarely last, and the lack of sleep can lead to serious mood swings with often devastating consequences.
No matter what depression or mania does to your sleep patterns, you have to fight the desire to change your sleep schedule. Make a pact with yourself and pick a set bedtime. When you're depressed, tell yourself you can only get in bed and sleep at those times. During the day, avoid naps and do whatever it takes to make yourself get out of bed in the morning. Mania sleep problems are much harder to treat because they feel positive at first. So much gets done, and it's great not to be depressed. But this is a false sense of security. All manias need to be reported to your doctor and treated with medications even when you think it's just the real you coming out after a depression.
Fill in the following list to remind yourself what it feels like when mania starts to disrupt your sleep:
Alcohol, Tranquilizers, Marijuana, and Caffeine Are Not Treatments For Sleep Problems
One thing is for sure: Alcohol, tranquilizers, marijuana, and caffeine are not solutions for sleep issues. They may seem like a solution, but they only add to and prolong the problem. It's very tempting to use such substances to regulate your sleep (or, in the case of caffeine, to combat daytime fatigue). They seem to work, which is why so many people self-medicate with these substances, but the truth is that they don't work in the long run. They're a mask for the symptoms rather than a solution, and you may find yourself with an addiction problem that truly exacerbates your mood swings. The reason that these substances are so dangerous is that their outward effects are quite different from what they actually do to your brain. Alcohol and tranquilizers, if taken in large enough amounts, can promote drowsiness and make it easier to fall asleep. However, it has been well documented that these drugs reduce the amount of time people spend in deep sleep and also often make depression a lot worse. Caffeine ingested in amounts above 250 mg per day can also reduce time spent in deep sleep.
As hard as it is, try to limit these substances and look to more realistic treatments for your sleep issues. You can use accepted herbs such as chamomile for relaxation and peppermint for energy as well as homeopathic treatments or exercise for sleep issues. These solutions rarely have side effects and are less likely to cause you problems in the future. It's true that they don't seem to work as well at first, but over time your body can start to self-regulate; you will find you don't feel the need for the unhealthy substances as much as you used to. You really do have to think long into the future when it comes to what you put in your body. Don't add to your brain's regulatory problems by taking substances that affect your sleep and only make things worse.
The following are some helpful tips for avoiding sleep problems:
Avoid working odd hours, especially shift work.
Limit travel in different time zones.
Set a go-to-sleep time and wake-up time, and stay in bed the entire time whether you're asleep or not.
Create a sleep ritual that helps you get to sleep normally.
Learn about natural sleep aids. (Always keep your physician posted about any and all over-the-counter and natural products you are using.)
Know what triggers your sleep problems.
Call your doctor at the first signs of mania.
This can be a daunting process if your work includes many of the issues addressed by the above tips. It really is up to you to decide if your lifestyle causes more problems than the job is worth. The journal section of this book includes an area where you can chart the number of hours you sleep. This can help you look for signs of mania and depression as well as keep your doctor informed of your sleep issues.
Why You Crave Junk Food
As you know, because you have bipolar disorder, your brain has trouble regulating itself. It's natural that you may want to treat bipolar disorder mood swings by eating foods that quickly increase energy and seem to lift your mood. The problem is that these quick fixes are often brought on by blood sugar changes, and are not an effective way to treat the mood swings. "Regular fluctuations in mood and energy are often linked to highs and lows in blood-sugar levels. These in turn are linked to the food we eat and drink, particularly sweet, sugary, and starchy foods. Such foods may temporarily fulfill a craving brought on by sudden tiredness and irritability, but they also cause our blood-sugar levels-and with them, our energy and mood-to seesaw. That's why, says Natalie Savona in The Kitchen Shrink, "Maintaining even blood-sugar levels is, therefore, one of the most crucial factors in improving our moods." It's actually more effective to balance moods with foods than to use food as a quick way out of a mood swing.