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If you’re in the middle of a manic episode, it’s understandable if you’re having trouble falling asleep. Manic sleep disruptions can create a downward spiral into hypomania (near constant irritability) and even full-blown mania, and this can be really tough to stop. Bipolar disorder can cause periods of mania and depression where you either can’t sleep, or end up sleeping way too much. This can lead to a vicious cycle where too much sleep leads to too little sleep and vice versa. In this article, we’ll break down everything you need to know about getting some shuteye when you’re in a manic episode so that you can finally get the rest you need.
Steps
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Accept that you’re having a tough time right now. If you’re working through a manic episode, it’s understandable if you’re struggling to sleep—and that’s okay. It’s going to be difficult to fall asleep if you keep focusing on how impossible it is to fall asleep, so take a deep breath. Acknowledge the reality, show yourself empathy, and remember that this is temporary. [1] X Research source
- Remember that this isn’t your fault. Manic bipolar episodes can be uncomfortable and upsetting, but you didn’t do anything to cause this.
- If you’ve experienced a manic episode before, you know that you will get through this. As difficult as it may be to sleep right now, you will fall asleep eventually.
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Stay still to break your impulse to move or fidget. Since you’re in a manic episode, you likely have the impulse to do something. If you’re twirling your hair, picking your nails, or twisting and turning, you’ll activate your nervous system and keep yourself awake. Lie as still as possible. Try leaving your hands in one place and focus on keeping your body quiet. This will make it a lot easier to actually fall asleep. [2] X Expert Source Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020.- You could literally picture yourself as a statue or pretend you’re a robot. Some people with bipolar find this kind of visualization helpful.
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Recite a calming song or poem in your mind. If your thoughts are racing, try replacing your obsessive thinking with something more relaxing. In your head, recite the lyrics of a beautiful song that you love. Alternatively, you can go through a poem you enjoy, or try to remember a poem you had to memorize in school. This can stop wild, racing thoughts in their tracks so you can sleep. [3] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- If you’re sleeping alone, you can try humming or singing quietly. That might have a calming effect and help you get into the right headspace to fall asleep.
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Create a list in your head to distract yourself. If the gears in your mind just can’t stop turning, give them a productive task with no clear end—like making a list in your head! You might try listing every street in your hometown in order, or rank your favorite movies. Alternatively, you could create a lineup for a fictional music festival, or make a list of dream jobs. [4] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- Any ideas or thoughts that occupy your mind and keep you from hyper-fixating on whatever is keeping you awake should help.
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Listen to relaxing music to redirect your focus. Throw on some quiet, calming music and focus on the soothing music while you lie still in bed. Classical, jazz, lofi instrumental, and folk music are all excellent options. Keep the volume low and just track the tune. You should find yourself calming down and getting ready to sleep in no time. [5] X Expert Source Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020.- Some people with bipolar enjoy listening to binaural beats. These are meditative songs that only rely on 2-3 tones, which supposedly helps your brain relax. There isn’t a ton of science on it, but some people seem to think they work, so it’s worth giving a shot! [6] X Research source You can find these songs by searching online. They’re also on Spotify and YouTube.
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Try a deep breathing exercise to relax your body. Place one hand on the chest and one hand on the stomach to monitor your breaths. Take a long, slow breath through your nose and feel the air filling up your lungs, then your stomach. Slowly release the air from your mouth, feeling your stomach deflate as the air leaves. Practice doing 4 to 6 breaths per minute, repeating the cycle for 10 or more times. [7] X Trustworthy Source US Department of Veterans Affairs U.S. government agency providing healthcare and resources to veterans Go to source
- Get ready for bed as you normally would but perform this exercise to help calm your mind and make getting to sleep easier. You may also perform this exercise while sitting in a chair.
- Deep breathing can be helpful for calming the rapid thoughts and anxiety that may accompany mania during any time of the day or night. No one has to know you're even doing the exercise.
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Get up and do something calming if you can't fall asleep. If you can't sleep after 15-20 minutes, don't just lie in bed awake. Get up and do something very relaxing that doesn’t involve turning on a ton of lights or looking at a screen. That might mean listening to soothing music or taking a bath, for instance. After a few minutes of activity, try going back to bed again. [8] X Trustworthy Source Cleveland Clinic Educational website from one of the world's leading hospitals Go to source
- After 15-20 minutes of lying awake, you’re super likely to start focusing on how you can’t fall asleep. In a manic episode, that can spiral out of control fast.
- Do not look at the clock! If you keep focusing on how little sleep you’re going to get, you’ll likely just fixate on that thought which can keep you up even longer.
- Try reading a book, which will engage another sense (sight), so that you don’t feel trapped in your mind while you lie there in the dark. [9]
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Expert Source
Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020. - If you’re hypomanic, it’s possible that you’ll get super invested in what you’re reading and stay up even later. If that happens, it’s okay. You’re better off reading than lying in bed tossing and turning.
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Take any medications your psychiatrist gave you for sleep. If your doctor or psychiatrist has diagnosed you with bipolar disorder, they may have given you medication as a last resort for serious sleep issues. If you’re in a manic episode and struggling to sleep, now is the time to take it. [10] X Research source
- Only take medications as directed by your psychiatrist or doctor. Do not take more than directed, even if you’re really struggling to sleep.
- If you have not been prescribed any sleep medication, you can try taking 2 mg of melatonin with a doctor’s permission. This is a hormone that is naturally secreted by the body when it’s dark out and basically tells your body to go to sleep. [11]
X
Expert Source
Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020.
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Establish a regular nightly routine and stick with it. You may be able to prevent manic episodes by practicing good sleep hygiene. This can be very effective at curing sleeplessness in people with bipolar disorder—even those in a manic episode. Develop a wind-down routine to get you in the right frame of mind for sleep. [12] X Trustworthy Source Harvard Medical School Harvard Medical School's Educational Site for the Public Go to source
- A nightly routine may consist of doing light stretching, tidying up your home, preparing your clothing for the following day, taking a hot bath, and reading a book.
- Try to do things that do not involve bright lights or technology since these things do not signal to your brain that it is sleep time. [13] X Research source
- Get ready for bed at the same time every night, and turn off all of your electronics at least an hour before that time. [14]
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Expert Source
Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020.
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Use your bedroom exclusively as a place to sleep. If you are a person that does work on your laptop in bed or watches TV while you’re lying down, cutting back on that will help. Treating your bed like it’s a sacred space for slumber will make it a lot easier to sleep. Try moving distracting activities from the bedroom and do these in another area. [15] X Research source
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Maintain a dark, cool, and comfortable bedroom. If your bedroom is cozy and inviting it will likely be easier to fall asleep there. Get a cozy mattress, bedding, and pillows to create an environment conducive to sleeping. In addition, cover your windows with blackout curtains to let minimal light in, and turn down your thermostat to a cool temperature. [16] X Research source
- If you have roommates or you live with your family and they make noise at night, put earplugs in.
- Get an eye cover if you can’t practically keep light from bleeding into your room.
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Minimize alcohol and caffeine consumption before bed. Depending on the medications you are taking, you may have already been instructed to limit these beverages completely. However, if you have been cleared to drink alcohol and caffeine, keep consumption to several hours before bed. [17] X Research source
- You may be surprised at the advice about not drinking alcohol before bed. Most people will feel drowsy after one or two drinks. Even though alcohol may help you fall asleep, it does not promote good quality sleep and alcohol is a common trigger for manic episodes.
- Caffeine is a stimulant, so the last thing you want to do in the hours before bed is stimulate yourself even more than you already may be with manic symptoms. Cut caffeine intake in the afternoon to sleep better at night.
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Stop taking naps during the day. Taking a power nap every now and then is no big deal, but if you’re regularly taking extended naps, it will interfere with your sleep cycle. Napping can make it harder to fall asleep come nighttime, which will keep you up late and increase the need for a nap the following day. This vicious cycle can be tough to get out of, so cut the naps out entirely. [18] X Trustworthy Source HelpGuide Nonprofit organization dedicated to providing free, evidence-based mental health and wellness resources. Go to source
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Take a bath to physically calm your body. If you’re unable to sleep or you want to calm down before your bedtime, draw a warm bath and soak in the water. Light a few candles and throw on some relaxing music if you’d like. The warm water can help ground you and soothe your urge to fixate or ruminate on something outside of yourself, which should make it much easier to fall asleep. [19] X Expert Source Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020.- If you don’t like soaking, a warm shower should have the same effect.
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Meditate for a few minutes daily to center yourself before bed. Meditating is a terrific way to cleanse your mind of negative thoughts and promote relaxation. Sit in a quiet room with your legs crossed on the floor or with your back straight in a chair. Close your eyes. Breathe normally, but focus your attention on each inhale and exhale. Refuse to let your mind wander, returning your attention to the breath each time you go astray. [20] X Research source
- Do this for a few minutes until you build up to longer periods.
- Even just 13 minutes of daily meditation is scientifically proven to improve your memory, mood, and attention. [21] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- If you find it difficult to meditate alone, look online for a guided meditation video.
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Try progressive muscle relaxation before you lie down. Engaging in progressive muscle relaxation can calm your central nervous system and help you fall asleep easier. [22] X Expert Source Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020. Sit comfortably in a chair. Take a few deep breaths, breathing in calm and breathing out tension. Slowly, moving up through your body, tense one muscle group and hold it for a few seconds. Release the tension and notice how it feels. Move up to the next muscle group until you have done your entire body. [23] X Research source- Roughly 20 minutes of deep muscle relaxation can dramatically improve your mood and sense of calm. [24] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
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Get regular physical activity to regulate your symptoms of bipolar. Exercise can be a great way to calm anxiety and keep your mood stable during a manic phase of bipolar disorder. [25] X Research source However, to keep intense activity from disrupting your sleep, try working out in the morning or at least several hours before bed. Aim to get at least 150 minutes of exercise a week. [26] X Trustworthy Source Centers for Disease Control and Prevention Main public health institute for the US, run by the Dept. of Health and Human Services Go to source
- Your exercise regimen can include moderate activities like yoga, Pilates, or a walk through the park. You can also engage in more vigorous forms of exercise such as running or high-intensity interval training.
- No matter what type of exercise you choose, the benefits outweigh those of not doing any at all. Regular exercise can improve mood, lower risk of disease, and even help with the depressive episodes you experience with bipolar. [27] X Trustworthy Source Centers for Disease Control and Prevention Main public health institute for the US, run by the Dept. of Health and Human Services Go to source
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Turn on a guided imagery video to help ease into sleep. This form of relaxation involves a number of techniques that use the senses to reduce anxiety and stress. A guided imagery session may require you to imagine that you are on a serene walk through a meadow or wading through the ocean. [28] X Expert Source Noel Hunter, Psy.D
Clinical Psychologist Expert Interview. 18 December 2020.- You can find plenty of these videos online on sites like YouTube.
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Stay away from your triggers, especially later in the day. Many (but not all) people with bipolar have triggers that can send them into a manic or depressive episode. If you have any known triggers, do your best to avoid them. If you have to tackle something stressful or triggering, do it as early in the day as possible to give yourself plenty of time to recover. [29] X Trustworthy Source HelpGuide Nonprofit organization dedicated to providing free, evidence-based mental health and wellness resources. Go to source
- Common triggers include stress, conflict with others, or difficult work.
- Some triggers are unavoidable, like seasonal changes. Just try to be cognizant of these periods and prepare for them ahead of time by keeping your schedule as open as possible and preparing to relax.
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Find a psychiatrist with experience in treating bipolar disorder. Your psychiatrist will help you determine a medication regimen that will help you control symptoms of bipolar disorder. Always take your medications as prescribed, since skipping a dose may induce a manic episode. Alert your psychiatrist if you are having sleep problems. Consistent sleep deprivation may exacerbate symptoms of bipolar disorder, so don’t hesitate to get help! [30] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source
- Many of the common antidepressants prescribed for bipolar disorder may actually improve your sleep schedule. [31] X Trustworthy Source National Institute of Mental Health Informational website from U.S. government focused on the understanding and treatment of mental illness. Go to source
- If you are taking medications and you feel like they’re interfering with your sleep, talk to your doctor to see if you can change your meds or add additional meds to your current regimen.
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Consider prescription sleep aids if this is a chronic issue. Medications like Trazadone and Seroquel are extremely popular non-addictive sleep aids that can be a huge help during bouts of hypomania where sleep is extremely difficult. [32] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source Benzodiazepines like zolpidem and lorazepam are also commonly prescribed for occasional insomnia. If your psychiatrist thinks medications are appropriate, weigh the pros and cons with them. [33] X Research source
- Seroquel is an antipsychotic that is non-habit forming. It works by blocking the serotonin receptors in your brain that keep your imagination active, which can make it super easy to sleep. [34] X Research source
- Trazadone is an antidepressant that works similarly to Seroquel. It has the added benefit of soothing the impulse to move, which is a big barrier for many people with bipolar disorder who have insomnia. [35] X Trustworthy Source MedlinePlus Collection of medical information sourced from the US National Library of Medicine Go to source
- Benzodiazepines can be intimidating because they’re habit-forming with long-term use. However, they can be a great solution for occasional bipolar insomnia since they’re so calming. [36] X Research source
- Your psychiatrist may also suggest non-addictive sleep aids that can be purchased over-the-counter, like diphenhydramine (Benadryl). [37] X Research source
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Try interpersonal and social rhythms therapy (IPSRT) if you want help with routines. This is a form of psychotherapy based upon the idea that bipolar disorder can be caused or made worse by disruptions to circadian rhythms and sleep deprivation. Its goal is to reduce the reoccurrence of manic episodes. [38] X Trustworthy Source PubMed Central Journal archive from the U.S. National Institutes of Health Go to source IPSRT can be conducted one-on-one or in a group setting. It focuses on helping people with mood disorders like yourself better manage their everyday lives with better sleep routines. [39] X Research source
- These therapies also often cover strategies to improve and stabilize your energy levels, as well. This can be deeply helpful during periods of hypersomnia, which is the opposite of hypermania.
- You can find a therapist who specializes in IPSRT by looking online. This isn’t a particularly uncommon school of therapy, so you can always ask if a therapist is familiar with it before choosing them. [40] X Research source
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Expert Q&A
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QuestionWhat should I do if I can't sleep?Dr. Noel Hunter is a Clinical Psychologist based in New York City. She is the director and founder of MindClear Integrative Psychotherapy. She specializes in using a trauma-informed, humanistic approach for treating and advocating for people diagnosed with mental disorders. Dr. Hunter holds a BA in Psychology from the University of South Florida, an MA in Psychology from New York University, and a doctorate in Psychology (Psy.D) from Long Island University. She has been featured in National Geographic, BBC News, CNN, TalkSpace, and Parents magazine. She is also the author of the book Trauma and Madness in Mental Health Services.Get out of bed, but stay near the bed. Then, do something relaxing, like listening to calming music, taking a bath, or reading a book. You could also engage in a guided body scan, progressive muscle relaxation, or use some kind of sleep-focused video or talk you find online. Avoid doing anything active, as that's going to make it even harder to fall asleep.
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QuestionHow do you sleep when manic?Dr. Noel Hunter is a Clinical Psychologist based in New York City. She is the director and founder of MindClear Integrative Psychotherapy. She specializes in using a trauma-informed, humanistic approach for treating and advocating for people diagnosed with mental disorders. Dr. Hunter holds a BA in Psychology from the University of South Florida, an MA in Psychology from New York University, and a doctorate in Psychology (Psy.D) from Long Island University. She has been featured in National Geographic, BBC News, CNN, TalkSpace, and Parents magazine. She is also the author of the book Trauma and Madness in Mental Health Services.Sometimes people do need help with sleep, whether that means taking melatonin or something that's prescribed. As long as it's only on a short-term basis, if you're really in an intense manic state, that might be necessary.
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Warnings
- If you're thinking about suicide and need immediate help, please contact a suicide prevention hotline right away, such as the 988 Suicide and Crisis Lifeline if you're in the United States, which can be reached by calling or texting 988.Thanks
- Maintaining healthy sleep habits should help you to better control sleeplessness and excitability that may occur with mania. Try to avoid sleeping too much or too little which can both drastically affect your mood with bipolar disorder. [41] X Trustworthy Source HelpGuide Nonprofit organization dedicated to providing free, evidence-based mental health and wellness resources. Go to sourceThanks
- Always talk to your primary psychiatrist before taking any over-the-counter medications or before commencing any new regimens. Small changes in your life may upset your mood, so get the OK from your doctor beforehand. [42] X Trustworthy Source Harvard Medical School Harvard Medical School's Educational Site for the Public Go to sourceThanks
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References
- ↑ https://psychcentral.com/bipolar/strategies-for-reducing-signs-of-mania-in-bipolar-disorder
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384231/
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384231/
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.psychologytoday.com/us/basics/binaural-beats
- ↑ https://www.va.gov/vetsinworkplace/docs/em_eap_exercise_breathing.asp
- ↑ https://health.clevelandclinic.org/5-strategies-that-will-help-you-get-back-to-sleep/
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.psychiatrictimes.com/view/new-directions-for-insomnia-and-bipolar-disorder
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.health.harvard.edu/staying-healthy/better-sleep-naturally
- ↑ https://www.psychiatrictimes.com/view/new-directions-for-insomnia-and-bipolar-disorder
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.sleepassociation.org/blog-post/why-you-should-only-use-your-bed-for-sleeping/
- ↑ https://bettersleep.org/better-sleep/the-ideal-bedroom/
- ↑ http://sleepfoundation.org/bedroom/taste.php
- ↑ https://www.helpguide.org/articles/bipolar-disorder/living-with-bipolar-disorder.htm
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://psychcentral.com/bipolar/meditation-and-bipolar-disorder-symptoms
- ↑ https://pubmed.ncbi.nlm.nih.gov/30153464/
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.anxietycanada.com/sites/default/files/MuscleRelaxation.pdf
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272667/
- ↑ https://adaa.org/understanding-anxiety/related-illnesses/bipolar-disorder-2
- ↑ https://www.cdc.gov/physical-activity-basics/guidelines/adults.html
- ↑ https://www.cdc.gov/physical-activity-basics/about/index.html
- ↑ Noel Hunter, Psy.D. Clinical Psychologist. Expert Interview. 18 December 2020.
- ↑ https://www.helpguide.org/articles/bipolar-disorder/living-with-bipolar-disorder.htm
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321357/
- ↑ https://www.nimh.nih.gov/health/topics/mental-health-medications#part_149866
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977773/
- ↑ https://www.psychiatrictimes.com/view/new-directions-for-insomnia-and-bipolar-disorder
- ↑ https://www.drugs.com/seroquel.html
- ↑ https://medlineplus.gov/druginfo/meds/a681038.html
- ↑ https://www.drugs.com/drug-class/benzodiazepines.html
- ↑ https://www.nlm.nih.gov/medlineplus/druginfo/meds/a682539.html
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202498/
- ↑ https://www.ipsrt.org
- ↑ https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-020-00266-7
- ↑ https://www.helpguide.org/articles/bipolar-disorder/living-with-bipolar-disorder.htm
- ↑ https://www.health.harvard.edu/blog/how-to-talk-to-your-doctor-about-medication-2018042313696
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