Stability in Bipolar Disorder Requires Routine
Bipolar disorder, by its very nature, is not routine. People become manic unexpectedly and people get depressed unexpectedly. And during depression or mania, people become even more erratic in all areas of their lives.
So if bipolar disorder exists outside of a routine, what would happen if routine were applied to bipolar disorder?
Bipolar Disorder Requires Routines, a Strict Rhythm
Your average person has a pretty variable rhythm. People get less sleep on weekdays, go out to a party now and then, not getting to sleep until 2AM, sleep in on weekends, sometimes skip breakfast, drink more and less coffee, work more or less hours and exercise at different times during the day. This is not generally a big deal for people. That’s just part of life.
The problem is that for a bipolar, it’s a very detrimental part of life.
Many of us with bipolar, not to mention the people around us, have noticed that breaks in rhythm result in bipolar episodes. Most noticeable is changes in sleep, life changes and stress leading to episodes. Studies have borne out this observation. A change in life routine does, in fact, often precede an episode like hypomania or mania. A therapy (Social Rhythm Therapy) was designed to address just these points.
What Does Routine Mean in Bipolar Disorder?
I have found the single most important part of attaining and maintaining any sort of stability is keeping a routine. It is highly inconvenient, but nothing causes problems more than varying from it.
Here are some of the factors that should be controlled:
- Sleep – go to get at the same time every night and get up at the same time every day – in my opinion this is most important thing you can do for yourself. Even staying up late one night can increase the likelihood of an episode.
- Medications must be taken at exactly the same time every day in order to keep a steady blood-level of medication (it goes without saying, keep all doctor's appointments).
- Control stress – yup, everybody gets stressed. The important part is trying to avoid stress, lessen it and find ways to deal with it when it comes.
- Put effort into maintaining social relationships whenever possible.
- Get sunlight everyday – get a sunlamp if outdoor sun isn’t possible.
- Work consistent hours – shift-work should be avoided.
- Exercise every day – this can just be a 15 minute walk, honestly, even that can help.
- Eat a balanced diet – if you don't fuel your brain, it's natural that it would be upset
- Create a daily routine where as many pieces of your day as possible happen at the same time every day.
- Don’t drink (or take other drugs). Just don’t.
You may find other factors that are important for you.
Strict Routines Suck
Yes, they do. I can’t tell you how much I hate doing it every day of my life. But that doesn’t mean it isn’t worth it.
Is It Really Necessary to Control So Many Things?
In a word, yes. Bipolar disorder is a serious illness that destroys lives. It keeps people from working, it gets people fired, it breaks up relationships, it ruins friendships and on and on. So yes, it’s worth putting structure into your life to try to avoid those things, not to mention to avoid all the suffering you, personally, would undergo.
The Great Thing About a Routine
And here’s the best thing about creating a routine in your life – it’s a drug-free therapy. You can even do it without professional help. In a world of side-effects, toxicity, blood tests, weight gain and co-pays, that sounds like a really good treatment option to me.
Tracy, N. (2010, September 13). Stability in Bipolar Disorder Requires Routine, HealthyPlace. Retrieved on 2020, January 24 from https://www.healthyplace.com/blogs/breakingbipolar/2010/09/stability-in-bipolar-disorder-requires-routine
Author: Natasha Tracy
I TAKE MEDS, BUT MY LIFE IS A BIT DISORGANISED.
Thank-you for sharing your experience with everyone. I'm sure that others have benefited and can identify.
Just to clarify, caffeine is not actually harmful to bipolar disorder IF
- used in moderation
- you're not prone to psychosis
- you're not manic
- you're not prone to anxiety
I just want to clarify this so people don't think that a cup of coffee in the morning is harmful. However, you are absolutely right that large amounts of caffeine - which is a _drug_ - can be harmful.
I'm so thankful that I found your blog. I have stumbled onto the most stressful time in my life, and I've been diagnosed as Bipolar Disorder I since I was 9. Three months ago I found out that my husband had enough with dealing with me. Our marriage had been on the rocks for 2 years and we had tried desperetly to heal it, for our daughters sake, but to no avail. We finally decided that it was healthier for her if we split up. Since then I went into full mania. My daughter went to live with my mother (per my request) and I was left alone in an empty house. Which, for Bipolar people, we all know can be detrimental to be alone during any depressive or severely manic episode. It's not smart. I then discovered energy drinks, which I really feel necessary to share because of the scary tole that it took on my body.
March 1 I discovered Monster Energy drinks and 5 Hour Energy Shots. Since going into full mania after my husband left and my daughter went to live with my mother, I was desperate to find some relief and instead of turning to drugs and alcohol ( bc that scares me and I know it's super unhealthy for Bipolar people, no one told me about caffeine), I turned to energy drinks which would in turn further increase my instability and mania and pushing me further and further into quite possibly the biggest crash of my life. I like the Mania episodes solely for the energy it brings, bc productiveness is like an addiction to me, the more productive I am, the more needed and wanted I feel. Which for me, rejection is a HUGE issue and usually pushes me into a depressive episode. So the productivity I experience in Manic episodes is like a drug to me.
Two weeks ago, I went to the doctor with seriously horrible migraines, stomach pain, back pain, nausea, vomiting, and an ending diagnosis that scared me to death. he ran some tests and found, of course, that the energy drinks had given me a horrible UTI and that's where all the stomach pain was coming from, but what he told me next I was HIGHLY unprepared for. The high amounts of caffeine I had been intaking for over three months had affected my brain and the chemicals in it so negatively that the Norepenephrine, Dopamine, and Seratonin had become so sluggish and thick due to the high amounts of caffeine that I had been having, that they were unable to travel through the Nuerotransmitters in my brain to reach all Lobes of my brain. I had only had access to the Frontal lobe of my brain and it had left out the Temporal and Occipital Lobes. Not only was I not using all of my brain, the Caffeine had caused my brain to swell to try and overwork itself and get those chemical to the rest of the brain. I almost lost my job, my family, my child, and my life. Because, come to find out, the most common side effect of Caffeine to Bipolar people is suicide.
Now that I'm off Caffeine, my life has turned around DRASTIALLY!! My boss even came up to me and asked me how I did it....how I turned my entire demeanor around in less than two weeks. I'm now, in two weeks time, in line for a promotion and better hours and just got a raise! Please, if you have Bipolar Disorder, head my advice and stay away from caffeine. It nearly ruined me!!
That's certainly a possibility. I generally keep a list of requested topics and write about them as the mood strikes. I'll put this one on the list.
Maybe during hypomania isn't the best time to start. Perhaps start when you're more stable, and try something small. Don't try to regulate your life all at once or you'll be much less likely to succeed.
Good post though.
It's all part of the parcel and you wouldn't know it, but I counsel my patients about it all the time. I try to practice it when I remember - meditation, self-hypnosis, CBT, massage, EFT (tapping), mindefulness, praying, excercise, nutrition, self-soothing techniques such as epsom salts baths (water is a great healer).
I've taken courses/seminars at the hospital on depression and anxiety referred by the mental Health team (I live in British Columbia, Canada), and I've taken seminars on the same as a psychiatric nurse to help my patients - I am good at teaching and inspiring others, but my illness plus the time necessary for my distraught family does not allow me to follow all of my own advice.
My state of mind is better today although I am home nursing my psychotically ill child. I will have to cancel work tomorrow to care for him. Work has been my biggest life saver, mood brightener, but not for tomorrow.
And yes, simple, simple, simple! When it get's overwhelming, drop everything and all expectations of yourself! All will survive when you've gotten yourself off that hamster wheel and. It helps when in those darkest areas of depression to say STOP! You don't have to do anything, you can drop those expectations, and you don't have to worry and fret about those extreme painful and worrisome emotions. It is just the depression telling you lies and altering your perception - they are not facts, they are not truths. Just a pair of gray colored glasses the depression has placed on you.
In giving yourself that break from all that guilt (lies from the depression again) and expections of how you should feel, how you want things to be different, you take a lot of pressure off yourself and it recharges the mind by giving yourself permission to just be, warts and all.
For any of you that don't know about it, check out "The Changeways Program" - It's appropriate for anybody, was started by Psychologist Randy Paterson from Vancouver General Hospital, has gone worldwide, is offered in many languages - I teach it but forget to practice it, as I always say, you can take what you want from it and leave the rest.
I believe it was Einstein who said, make everything as simple as possible, but not too simple. I like that. Simple things are easier to remember.
Thanks for sharing your story, I hope some of what you read here helps.
It sounds like you're in a really tough situation. The only thing I can tell you is that it sounds like you might find life-skills-type-therapy helpful. For people in a chaotic environment, this type of therapy aims to give you the skills to handle it and even change it. There are many different types, your doctor should be able to help you. CBT or DBT type therapy also might help.
If you can help yourself and your son with life changes, it's much better for both of you than medication or ECT. Believe me.
Yes, all children need routine, but ill children _need_ it like they need oxygen. It's great that you've noticed that and see the importance. It's something that no one seems to tell you about.
I specifically when into nursing not only to help other people, but because I couldn't stand regularity. I grew up in an abusive, neglectful, unstable environment because my parents couldn't handle parenting - I lived in 11 different homes with different family members until I met my husband at age 16 - over 30 years ago. Since then I've had complete stability and unconditional love, but the dislike for routine was already ingrained in me.
But that has affected my special needs mentally ill son - he couldn't get the consistancy he needed (even though he has love, food, stable home and school), I could never remain consistant with all the millions of "consistancy" suggestions I was told by the experts I had to do. Both he and I are much more ill because of each other. I am now too burnt out and hands off with him, but my husband has taken over and able to supply him with the constancy that he needs.
With my son, the home environment is so toxic as we all sit on eggshells waiting for the next crisis and explosion. The stress never ends, adversity lives in my home and won't leave. I've even stopped exploding in frustration when things go wrong because it's become a constant fixture and almost expected, or I am un-surprised when I'm knocked off my feet again - the death of both parents and a brother-in-law, car accidents, ambulance calls for my 10 year old for accidents while on outings, constant flu's, illnesses further stopping and disrupting our lives, and broken appliances, plumbing, electronics over and over one after the other - it's actually comical. So no freedom from stress.
I miss not being able to drink my peach cidar. It now puts me into a further depression that lasts for days, so no alcohol. My 10 year old daughter is so traumatized she sleeps with us and I have to go to bed with her every night at nine o'clock.
We can't go anywhere as a family or have anyone over due to my son's illness - he can't tolerate it and it puts him over the edge. We can't even eat dinner together at the table. I can't cook for anyone because they all hate everything. Meals are one rejecting disaster after another. A total nightmare.
I had one manic episode last year which I guess confirms the diagnosis of bipolar disorder - difficult to accept. I want the doctor to do ECT because all of the drugs no longer help my depression, but he won't because he says it's from my home environment and feels my son should be in a foster home. Not on your life!! We don't know if he's bipolar, schizo. or what - right now it is definately psychosis.
My one manic episode was great because I got all those intolerable, boring tasks off my lists - I made about 25 pages of lists. But it was followed by a severe crash of depression, because the manic energy robbed the energy and I had to pay it back. It was probably never would have surfaced had it not been for all the stress. I became extremely ill on the Epival and Lithium. The Lamotrigine doesn't appear to help the depression, although I finally stopped feeling suicidal last January. And in that suicidal state, I lost all rational thought of what a suicide could do to my children and family. The only thing I had to go on is the fact that I'm a psychiatric nurse and I knew to sedate the heck out of myself until the extreme emotion passed.
So I've now run out of options, except I was well enough to end the 18 month medical leave I had to take and return to work. And possibly I'll become well again in around 6 years when I am no longer legally responsible for my son's care - however my husband refuses to abandon his ill son, I hope my daughter and I don't have to move out - what a horrible fate to give my husband - to force him to choose between his extremely ill son, or his less ill wife and normal daughter. I hope it never comes to that.
you've earned the title, love!
"You are the Bipolar Whisperer."
I may steal that. Thanks.
You are the Bipolar Whisperer.
I am currently working on my routine and time management. I will not let BP steal all my time! Because it can be so overwhelming, I use lists and systematically knock things off it one at a time. It helps to take this one in bites. The importance of routine cannot be overstated.