How to Sleep with Bipolar — Good Sleep Hygiene and Sleep Tips

Sleeping with bipolar disorder is very hard so this article is devoted to talking about how to sleep with bipolar disorder, what sleep hygiene is and additional sleep tips. I’ve talked about some of these things before, but this post will bring together all the techniques I have previously discussed. Using all these sleep tips, I have been able to better regulate my sleep even with bipolar disorder, and I can tell you when I falter and don’t do these things, my sleep almost always suffers. Learning how to sleep with bipolar disorder has been hard, but good sleep hygiene and other positive sleep habits help.

Why Is Sleep So Hard for People with Bipolar Disorder?

Bipolar disorder is, among other things, a circadian rhythm disorder. Your circadian rhythm, also known as your “body clock,” is what tells your body when to wake up in the morning and when to go to sleep at night, among other things. It makes sense, then, if this clock is broken in bipolar disorder, sleep will always be a challenge. And this, intuitively, makes sense. We struggle to find a sense of balance in many ways in bipolar disorder and sleep is simply another one of those ways.

(Dr. Jim Phelps has done an amazing job of discussing how bipolar disorder is a “body clock” disorder and how lithium can actually help fix that clock. Read about it here.)

Sleeping with Bipolar Is Easier with Good Sleep Hygiene — What Is Sleep Hygiene?

I was doing a question-and-answer session last week for World Bipolar Disorder (you can see a recording of it on Instagram here) and I mentioned sleep hygiene. I promised I’d write more about it here.

According to SleepFoundation.org, sleep hygiene is:

“. . . a variety of different practices and habits that are necessary to have good nighttime sleep quality and full daytime alertness. Obtaining healthy sleep is important for both physical and mental health. It can also improve productivity and overall quality of life. Everyone, from children to older adults, can benefit from practicing good sleep habits.

So, basically sleep hygiene is the stuff that allows you to sleep and sleep is the stuff that allows you to do most everything else. And while the above may focus on “productivity” and the nebulous concept of “quality of life,” for people with bipolar disorder, sleep gives us the opportunity to have fewer mood fluctuations. We all know how crazy our moods get when we don’t get enough sleep. It used to be that any day I went to bed late and didn’t sleep well, I was automatically depressed the next day.

The #1 Tip for Good Sleep with Bipolar Disorder

People aren’t going to like this one, but the number one tip for sleep and bipolar disorder is getting up at the same time every morning and going to bed at the same time every night. This means no sleeping in on weekends. Every single day is bookended at exactly the same times. If I could make every person with bipolar disorder in the world do this, our global pain burden would decrease — really.

Now, I know that people don’t like that strict of a bipolar routine. I get it. But it’s the number one thing you can do to sleep better with bipolar disorder. If you don’t believe me, give it a month. You’ll be a changed person. You’ll be a more rigid person, sure, but you’ll also be a much more stable person, too.

What Is Good Sleep Hygiene for Sleeping with Bipolar?

SleepFoundation.org has listed many aspects of good sleep hygiene. I don’t agree with all of them, but, in general, they’re good ideas. They include:

• Limiting daytime naps to 30 minutes — I think this is probably a good idea for your average Joe, but the thing is, people with bipolar disorder are not average. I suspect many people with bipolar disorder need far more daytime sleep than this. That said, don’t expect daytime sleep to ever make up for bad nighttime sleep.
• Avoiding stimulants like caffeine and nicotine close to bedtime — I would say that as long as you don’t drink your coffee after, say, 2:00 p.m. (for an early bedtime) you’re probably okay. (Caffeine has a four-hour half-life.)
• Using alcohol “in moderation” — Alcohol can make you fall asleep faster but it then disrupts sleep in the second half of the night. Personally, I’ve found that if I even have a bit of a buzz when I go to sleep, I know I’m not going to sleep well. My rule is that my body has to have processed the alcohol before my scheduled bedtime (that’s assuming I’ve consumed any at all which is extremely rare; remember, alcohol is a depressant).
• Exercising — As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality.  For the best night’s sleep, most people should avoid strenuous workouts close to bedtime.
• Avoiding certain foods that can disrupt sleep — These foods include heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks.
• Getting enough natural light — Adequate exposure to natural light in the day and darkness at night is critical for some people’s circadian rhythm. In fact, both light therapy and dark therapy can be helpful in the treatment of bipolar disorder.
• Establishing a bedtime routine — I have talked about bipolar routines before, and a big part of mine is my bedtime routine. A bedtime routine helps to train your brain and tell it that it’s time for bed. The following could be a part of your bedtime routine: a warm shower/bath, reading a book, light stretching exercises, and putting on your blue-light-blocking glasses (more on that later). (You could also have a wakeup routine, by the way, and that’s when you might use your lightbox. Lightboxes can help you get the light you need during the day. Do not try a lightbox without talking to your psychiatrist first.)
• Try to avoid getting upset before you go to sleep — Obviously, upsetting conversations often aren’t planned, but when possible, wait for the morning (and maybe skip the really emotional movie right before bedtime, too).
• Making sure you love your sleep environment — This includes all the things that would make you want to sleep in your bed like comfy pillows and a great mattress, but also, the room should be cool (between 60 and 67 degrees Fahrenheit), dark and quiet. It has been shown that even a sliver of light can affect sleep quality. Consider blackout curtains, sleep masks and earplugs. “White noise” machines, humidifiers, air conditioners, fans and other devices can also make the sleep environment more relaxing.

The above are a part of sleep hygiene, but for bipolar disorder, I have sleep tips to offer too.

Sleep Tips for Bipolar Disorder

If you want to sleep with bipolar disorder then a major sleep tip for bipolar disorder (really it ties with number one, above) is that you need to take your medication on time, every day. Medications are often activating or sedating and when you take either type is going to affect how you function during the day and whether you can sleep at night.

Also, if you find you can’t sleep, it might be that you’re finding a nighttime medication activating. While some medications are known to be activating for most, we’re all different, and you might find something activating to the point of sleep disruption that other people don’t. For this reason, you may want to try moving a morning medication to the evening or vice versa. Also, you may have to swap out a medication that is too activating or too sedating. Don’t make these kinds of changes without talking to your doctor first, however.

Other sleep tips that can help with bipolar and sleep include:

• Stay away from blue light for an hour before bed. This means turn off the lights and get away from screens. Blue light can activate the part of your brain that says “stay awake.” Try reading before bed or get yourself a pair of blue-light-blocking glasses. They’re cheap on Amazon. These are the ones I like because they’re specifically for eye protection and not fashion. (I admit, there’s some controversy right now regarding blue light affecting sleep. That said, I’ve found these glasses helpful and it’s a small investment.)
• Calm your brain down before bed. Don’t play video games. Don’t watch exciting shows. Even if you have blue-light-blocking glasses on, that’s not going to help you calm down that type of action in your brain.
• Learn to meditate or use formal relaxation techniques. I’ve tried mindfulness meditation and I found mindfulness meditation didn’t help my bipolar. That said, the relaxation exercises for both body and mind that are associated with meditation can be very helpful in helping you sleep.
• Try a “mind machine.” A mind machine is an audio-visual stimulation device. Basically, it actives your brain in specific ways using sound and light. Now, the research on this can be a bit sketchy so I don’t recognize spending oodles of money on it, unless, of course, you have oodles of money just laying around. Instead, try an app for your phone. A pro license (inexpensive) for Mindroid on Android allows you to use your phone as a mind machine. (I’m sure there’s something similar for the iPhone.) I, personally, have found this very helpful when trying to get to sleep. If you try this, you might want to try it with headphones you can sleep in so you don’t have to worry about falling asleep with uncomfortable headphones in.

Bipolar Disorder and Sleep Medication — Sleep Medication Tips

I’ve focused this article on everything but sleep medication. That’s because a lot of people don’t want to use sleep medication. I understand this. That said, I use sleep medication. I know that even with all the above, I would never be able to sleep. That’s just my brain for you. I need medication plus the above.

If you’ve done all the above for a month (because these changes take time to work) and nothing is helping, I recommend you look into sleep medication with your psychiatrist. I do not recommend you try something over the counter without talking to your psychiatrist first.

There are three kinds of sleep medication and the one that’s right for you, is personal.

Here’s where I remind you that I’m not a doctor and you should always have thorough conversations about the positives and negatives of any sleep medication with him or her.

Here are my sleep medication tips:

1. The preferred sleep medication is an antidepressant or antipsychotic. These are preferred because they are non-habit-forming (i.e., not addictive). Antidepressant options include trazodone and antipsychotics like quetiapine (Seroquel). Keep in mind that taking these drugs for sleep is not the same as taking them for bipolar. For sleep, the doses are usually small and this keeps the side effects to a minimum. (These are off label uses, by the way (i.e., they are not Food and Drug Administration approved), but are common.)
2. Over-the-counter (OTC) sleep medications are available but not recommended. These drugs are habit-forming and one recent study came out saying OTC sleep aids are linked to dementia so, if you ask me, long-term use is dangerous. (This, by the way, is on top of the fact that bipolar already makes you at greater risk for dementia.)
3. Prescription sleep medication is available and may be the best option when #1 doesn’t work. I will tell you upfront that some doctors don’t believe in prescribing this type of medication. Benzodiazepines and non-benzodiazepines (really called that) are in this class. They are habit-forming and some people do come to abuse them. If you have a history of addiction, these likely aren’t for you. That said, if you use these exactly as prescribed and in no other way, they can be very effective short- or even long-term. (Note that as one commenter points out below, there is some research that says using these types of medication beyond four weeks can be dangerous.)
4. Marijuana is an option for some (maybe). I know I said there are three classes, and basically, that’s true, but marijuana is kind of in its own class. Marijuana can help with sleep for some but I consider it a risky choice because there has not been the study on it to say that it is safe for people with a mental illness. In fact, it is decidedly unsafe for those with psychosis. Because of the lack of study and because it can induce psychosis, I can’t recommend it, but I know some people do use it. Proceed with extreme caution.

That’s what I know about how to sleep with bipolar disorder. I will try to keep these sleep tips updated as more occur to me or as I learn more.

Sweet dreams, folks.