Sleep

I think I may have found a way of staying stable...and it seems to be as simple as getting enough sleep. Yes, this does sound as if either (a) I'm a new age hippie caught on the newest fad or (b) it's too good to be true.

But it does work, and seems to work as well as or better than any of the drugs that I have taken to stabilise my moods. In fact, getting enough sleep is the only thing that has ever stopped me from falling into a depressive mood. None of the medications have ever did that. In addition, getting enough sleep also seems to prevent me from getting the manic highs.

It does seem too good to be true, doesn't it?

So here are the disclaimers.

So far, I have started this only four weeks. However, with my continuous rapid cycles, four weeks represents two hypomanic episodes and two depression episodes. So far none have occurred. Not even a mild mania or depression. For me, the results have been dramatic, and very noticeable to those around me.

We all react differently to each drug, and drugs that are effective for one person will not work for another. I am assuming that getting enough sleep will follow the same pattern and that not every person will find that it works for them. However, my intuition is that getting enough sleep is likely to have a higher success rate in keeping people stable than any drug.

I am unfortunately unable to hold a clinical trial to test my theory (and I hope that some researcher will). In the interim, if you try this, can you let me know if it is successful or if it didn't work for you.

I don't think it will work if you are currently depressed. Depression imposes its own odd sleeping patterns, and when we are depressed we sleep well in excess of what is normal. I don't think trying to impose an regular sleep cycle will make much of a difference.

It may work to stabilise you if you are manic. However, I have my doubts that a high energy manic person will be willing to go to sleep early for a number of nights in a row and be able to sleep a regular number of hours. Basically, it should work if you do what I suggest, but you'll have a difficult time doing which I suggest.

I think getting enough sleep will work best if you start when you are currently stable or almost stable. This way your sleep pattern is close to normal, and you have enough control to actually go to bed on schedule and get up when the alarm clock wakes you.

You need to be consistent. And getting a full night's sleep every night is much harder than it appears.

My experience is that just two nights of not getting enough sleep is enough to start the destabilisation process. It's that easy for things to go awry. I have tried this before, and those attempts have failed because of the night that I stayed up late to finish what I was working on, or to watch one more episode of Law and Order on television. Or just saying that I can get up late on Sunday so I can have a night out on Saturday.

It don't work so. Consistency is the key.

This

So - this is the magic solution, right? If I get enough sleep, my world will right itself and I won't be bipolar again and I can just get on with my life. Yes?

Well, I doubt it's quite that simple.

13 May 07

We all tend to aim to try to get stable and then to stay stable. But it's important to realise that getting stable and staying stable are two very different things and you need two different strategies to handle them.

Well, three strategies, one for getting stable from mania, one for getting stable from depression, and one for staying stable.

Don't assume that whatever you are doing to get stable will necessarily continue working to keep you stable. Once you become stable, you must keep on monitoring yourself just as much as if you are manic or depressed.

It is worth the effort to do the things that keep you stable because if you destabilise, it can take weeks and months to get back to being stable.

So much for the pep talk. What can you actually do to keep stable?

If your medications work, keep on taking them. Do not stop them just because you are feeling fine. This is not the flu and you are not taking aspirin. You are feeling better because you are taking your meds. Stop, and you have a good chance of having your mood swings begin again.

However, you shouldn't rely only on medications. They are not foolproof, and the concept "If you take your medication, then your moods will be stable" doesn't work. Do not expect to keep the same old habits as you used to and expect the medications to work to keep everything in place. Chances are, they won't.

Changing habits doesn't require you to change your life. But once your are reasonably stable, consider trying these to see if they help you to stay stable.

Sleep

My experience is that getting a good night's sleep is one of the best ways to stay stable, and about as effective as drugs. Aim for 7 1/2 to 8 hours of sleep every night.

The reverse effect also appears to be true. Not sleeping enough seems to be one of the major factors in causing me to destabilise.

This sounds good, doesn't it? It's cheap, doesn't have physical side effects, and is a really good excuse to get up late every morning. And everyone says getting a good night's sleep is a good thing.

It's also extremely difficult to put into practice consistently.

Think about it. When is the last time you had 8 hours sleep? When is the last time you had three consecutive nights of 8 hours sleep?

If the plan is to get up on a morning at 6:00 am, then you have to be in bed by 10:00 pm. That means if you are watching movies on television they have to start by 8:30pm. It also means no meeting friends for dinner at 7:00 pm because you'll never get home in time for ten; no late nights out on the town; leaving early at parties (or before they even start); no trying to finish some last minute paperwork after the kids are in bed; no going to bed at ten and having sex (go to bed earlier).

Of course you can get up later if you stay up late, but that's usually not practical on weekdays. And getting up later will mess up your morning schedule, which is also likely to cause you to destabilise.

The thing about using sleep to keep you stable is that it has to be consistent. You obviously don't have to do it every single night, but it should be close to that. The more nights you miss the full 8 hours, the less effective using sleep as a mood stabiliser is.

Conversely, if you have just a few hours sleep on consecutive nights, you should definitely monitor how you are feeling over the following few days to ensure that your moods don't start fluctuating.

You can't just decide to get eight hours sleep every night without planning it. We have all pretty much tied ourselves into lifestyles where it is impossible to do everything we want and still get enough sleep. You have to think about how you plan to sleep given your schedule and what you intend to give up doing to make it happen. Do not pretend that you will still be able to cram everything into less time.

One of the major things that will need to be sorted out is leisure time. Dinners with friends need to be scheduled earlier or become lunches. You need to go to the movies earlier. If you are meeting a group of friends on a Saturday evening, expect to be leaving early. If you have kids, let the spouse handle them after your bedtime.

If you do have to stay up late because you are invited to a wedding, or there is a play you want to see, or you just want a night out, or it's Thanksgiving evening, you must schedule it in. And you must ensure that the day before and after have your regular sleep pattern. If you have two engagements on two consecutive nights, you should forego one.

It's a bit tough, but then life's tough. And if you remain stable, you are actually on average more likely to go out than if you destabilise and get stuck home depressed for a month or two.

If you use the late hours as the quiet time for yourself, you need to figure out an alternative. See what you use the time for - destressing, having a cup of tea, doing household accounts, talking with your partner, reading, snacking - and see where else it can fit in. If you use the late hours for relaxing, consider using your exercise time as your personal time instead.

When you start going to be earlier, you may find that you can't get to sleep easily. That's probably normal as your body hasn't adjusted to the new rhythm yet. Try any of the usual recommendations for insomnia, but don't give up just because you don't like lying around in bed.

You may find out that you are going to bed earlier than everyone else, including your kids. There's nothing wrong with this. But whatever you do, never stay up later than everyone else. The chances that you will stay up until 2 am and then destabilise rise substantially.

C. always keeps an eye on me to make sure I go to bed on time, just like keeping an eye on me to make sure I take my medications. If C. goes to bed earlier than my usual bed time, I go to bed too because I'm not allowed to be the last one to go to bed.

Whatever you do, do NOT sit on the sofa and turn on the television. It's too easy to watch Law and Order until midnight. You are better off in bed.

Something to keep an eye on. If you regularly need seven hours of sleep, and you find that you are suddenly sleeping eight hours, check to see if you are becoming depressed. You could have just had a tiring day, but with our mood swings, it's always worthwhile to check to see if our moods are wobbling away from normal.

Variations:

I've been talking about 8 hours of sleep. But if less does you just fine, it's ok. You'll know you need less sleep generally if you keep on getting up an hour or 30 minutes earlier than you expect. However, if you are sleeping less than about 6 hours, you probably aren't getting enough sleep.

The Fine Print:

Sleeping tends to keep us stable. But if we are manic or depressed, our sleep patterns bear no relation to normality. I'm not sure that trying to implement a sleeping pattern while manic or depressed will help make you stable (but then again, it couldn't hurt).

Waking Up Early

You are likely to find that if you start going to bed early, you are awake at 5:00 am. Instead of tossing and turning in bed grumbling, take advantage of being awake.

My experience has been that getting up before everyone else is a good way to start the day unstressed. You don't have anyone to deal with, the house is quiet, and you don't have to start the mad morning rush just yet. It's a peaceful empty space to inhabit with no other people to deal with. It's absolutely wonderful.

And it does your mood good. I think we all need about 20-40 minutes of quiet time on mornings to let our moods settle into normality before starting the day's rush.

It's also a good time make yourself a cup of tea / coffee / hot chocolate and sit at the kitchen table and plan how the day is going to be. We need structure in order to cope well, and setting up how the day will be allows us to get through the day more easily.

The quiet time and the planning of the day go a long long way in keeping us from being increasingly stressed as the days go by. So we stay more stable.

This quiet time can take the place of your quiet time at the end of the day. If you come home from a long day, instead of trying to relax and unwind when you are tired and stressed (and no, sitting in front the television is not unwinding), go to bed early and wake up early to have your quiet time - you'll be refreshed and you'll enjoy the time more.

If you are a morning person, you are probably alert enough so that you can do household accounts, etc.. I tend to use this time to write e-mails and update the website.

Do not lie down on the couch and turn on the television.

You can use the time to do anything else you want, so long as you set aside the ten minutes or so to plan the day. This includes stretching, yoga, a bit of housework, even a morning run if that's your thing (after you planned your day, it's can also be a good time to sneak back in bed and jump your partner). However, on the days when you don't do what you planned to do, do not feel guilty and stressed. That would pretty much invalidate the whole point of having the quiet time. If you didn't do the yoga, it's ok, really.

If you are rising early, remember that getting a good night's sleep is more valuable than waking up early - if you have to drag yourself out of the bed, stay in it and go back to sleep.

However, if you are pretty consistent with waking up early, and you don't do it for a few days in a row, check to see if you are slipping into depression.

With a little luck, by the time the other people start rising, you'll have started into the day's rhythm smoothly and peacefully.

The Fine Print:

I have no idea if this will work properly in countries with winter, where you wake up to a cold house. If you are doing this, ensure that you are comfortable - warm robe, fuzzy slippers, hot chocolate, etc.. Getting up and being cold and miserable does you no good; you are better off sleeping. But still see if you can wake up 15 minutes earlier to make the plans for the day.

Exercise

Like sleep, exercise seems to work as effectively as antidepressants in keeping me stable. And the best part is that it doesn't take a lot of exercise to keep stable - it's not necessary to be running five miles every day.

There are however a few points to keep in mind. One of the first is that the exercise is better done outside, as opposed to being in a gym or on a treadmill at home.

I'm not sure entirely why this should be so, after all exercise is exercise. But being outside does make a difference - apparently just having nature around us works to make us feel better - less stressed, calmer, and more stable.

So if there is a park nearby, or if you live in a nicely wooded suburb or in the country - that's the place to be when you are exercising. Even better, if there is a pond or a river or a lake close by, find a path that carries you by it. Being by water also seems to work to make us feel better.

I've moved houses a lot, and even before I realised it made a difference, I always instinctively chose to live near water where possible, and always near a park.

However, if you can't make it outside, then exercising in a gym or at home works.

The second point is that this exercise is for keeping your moods stable. It is not about increasing how far or fast you can run, or about having the best time for swimming 30 lengths in the pool, or lifting the heaviest weights you can, or about winning your opponent in golf.

It is also not about improving your cardiovascular capacity or about burning calories to lose weight.

You can certainly add in any or all of those goals if you like. But you must remember you are piggy backing them onto the main goal of keeping your moods stable. If you do not, you are setting yourself up for disappointment. More on this later on.

You can choose pretty much about any exercise you want, but walking or running are the easiest to prepare for. And having something that is easy to prepare for makes a difference.

Remember, being stable doesn't mean that your moods are stable. It just means that your moods don't swing so intensely that you plunge into depression or go manic. But you are definitely going to have good days and blah days and really blah days.

Your exercise program has to be able to accommodate the fact that you will not always be at or near your peak. In fact it has to accommodate that there are days you'll be lucky if you just get out of the house.

My experience is that you need an exercise program that has at least three levels of intensity. One of them is the standard intensity - you get out, you have a good run, you perhaps push yourself a bit, and you come home feeling satisfied that you had a good day.

The second level is for the days you are feeling blah. You still have the ability to get out and exercise, but you know that you aren't going to do great. But that's ok. Remember the idea isn't to get faster or stronger, it's to keep your mood stable. Even a middling or just passable intensity of exercise will work fine to keep your moods stable.

The third level is for when you don't want to leave the house or exercise and you have to fight to drag yourself out of the house. At this level, anything goes, just so long as you get out of the house.

So how does that translate into an exercise program. Well, for me, standard intensity would be two circuits around a park near my house, making sure that I time the circuits to ensure that I keep up to speed. On these days I challenge myself to see if I can increase my overall speed and decrease my overall times. Total time for running would be about 35-40 minutes.

On blah days, I live with the fact that I'm going to have to struggle to make one circuit, but I figure that's better than nothing. On this circuit I feel tired and my breathing is laboured, but I know that I can definitely make one circuit because I usually do more than this. Total time would be about 25 minutes.

On really blah days, I don't even bother with putting on running shoes or shorts because it takes too much effort. I just go for a walk around the block in anything I have on - jeans, t-shirt, slippers. Or even work clothes. While this probably will never count as exercise, remember that's not the point. The point is trying to stabilise your moods - and a 10-20 minute walk can help in making you feel better.

When I used to swim, my program was 30-40 laps on a standard day, 20 laps on a blah day, and a walk on the very blah days.

You don't need to exercise every day - 3-4 times a week is fine. But going for a 10 minute stroll every day is always nice. If nothing else it gives you a 10 minute time out of your hectic day to relieve stress. Come home and before you settle into the evening activities, drop all your stuff and go out for a walk. Work clothes are fine - you aren't supposed to get all hot and sweaty on a stroll.

While any form of exercise can work, the more preparation stuff you have to do before you start exercising (including getting to and from your exercise location), the less likely it is you will exercise. That's why I tend to prefer walking or running - they are low preparation - although there have been days when putting on my running shoes was too much effort.

I'm not sure if having an exercise partner helps. On the one hand, having someone you are supposed to meet can provide you with an incentive to get out there. On the other hand, it also adds in another layer of complexity and preparation. Try it and see if it works for you - but don't feel as if it is your fault if it doesn't work.

I don't think it matters if you exercise on mornings or evenings. Personal preference and scheduling probably matter more.

There is one final benefit to exercising. If you get fitter, or you lose weight, you'll feel better about yourself. This increase in self image can also work to stabilise your moods, or to provide you with additional strength when you are feeling low. But, the reverse is also true. If you aim for getting fitter or losing weight, and you are unable to do so because of your mood swings, you are going to feel frustrated and your image as someone who can succeed will decrease. Be very careful that you do not set yourself up for this failure.

Always remember that the point of the exercise is to keep your moods stable. If you eventually run a marathon or if your waist size drops by three inches, those are great side benefits. But don't start off aiming for or expecting those benefits.

Rigid Organisation of Time - Get up at the same time, dress at the same time, go to work at the same time, go to sleep at the same time.

This provides a basic ordering to my life. If I drift from the this pattern without an obvious reason, it is an early warning signal. And the structure makes it easier fo

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