Bipolar diary – bipolar and circadian rhythms

I’ve been reading up on bipolar some more and learnt some very interesting stuff to do with how bipolar affects sleeping patterns. Once again I’m becoming more informed on the effect bipolar has on me and how it manifests itself in my behaviour. It’s weird to read about all these different things and to see how comprehensive and far-reaching the effects are. It’s tentacles spread through every facet of my life in a way that is startling.

I’m not feeling so downbeat today learning this stuff as I have been recently, I feel like I’m responding to things in a more considered way rather than the frenzy of responding emotionally to every new detail. I still feel like a slave to it, which, when everything is taken into account isn’t exactly that far from the truth, but really that’s neither here nor there, I have it, I have to deal with it, so I will.

In terms of sleep, and by association behaviour, people with bipolar, to put it simply, do not have the same circadian rhythms as normal people. In fact, just to sum this properly, here’s a passage from this page(link)


 

Bipolar is a Circadian Rhythm Disorder

I’ve said it before and I’ll say it again: bipolar is a circadian rhythm disorder. This means that your internal body clock – the thing that regulates sleep wake cycles, among other things – doesn’t work properly. In fact, according to the 2014 review Circadian rhythms and sleep in bipolar disorder: implications for pathophysiology and treatment:

Patients with bipolar disorder show altered rhythmicity in body temperature and melatonin rhythms, high day-to-day variability in activity and sleep timing, persistent disturbances of sleep or wake cycles, including disturbances of sleep continuity.

And they follow up with:

The internal clocks are, indeed, responsible for regulating a variety of physiologic functions, including appetitive behaviors, cognitive functions and metabolism . . . An underlying circadian pathology in bipolar disorder is a unifying explicatory model for the high psychiatric and medical comorbidity observed during the long-term course of the disorder.


 

Further in the article she writes –


 

What Happens to My Bipolar When My Sleep is Altered

I can say that as the researchers note above, my sleep continuity is almost always disrupted and I suspect it’s by the bipolar disorder. It’s extremely rare that I wake up in the morning without remembering moments of wakefulness during the night. The more wakeful moments I remember, the worse my day generally is.


 

I have noticed these things for a very long time and I too very, extremely rarely, sleep without having several periods of wakefulness during the night, which brings us onto routines, again from the same source:


 

Bipolar Disorder and Rhythm

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 andmaintaining 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:

  1. Sleep – go to get at the same time every night and get up at the same time every day– in my opinion this is the most important thing you can do for yourself. Even staying up late one night can increase the likelihood of an episode.
  2. Medications must be taken at exactly the same time every dayin order to keep a steady blood-level of medication (it goes without saying, keep all doctor’s appointments).
  3. 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.
  4. Put effort into maintaining social relationships whenever possible.
  5. Get sunlight everyday– get a sunlamp if outdoor sun isn’t possible.
  6. Work consistent hours– shift-work should be avoided.
  7. Exercise every day– this can just be a 15 minute walk, honestly, even that can help.
  8. Eat a balanced diet– if you don’t fuel your brain, it’s natural that it would be upset
  9. Create a daily routinewhere as many pieces of your day as possible happen at the same time every day.
  10. 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.


 

I’ve looked at other sources that say pretty much the same things here and like I say, I have noticed in the past that when I have been able to keep a strict routine myself, I fare better. Of course, this was during the period of my life when a) I wasn’t aware I had bipolar, just aware that something wasn’t right, and so b) didn’t know how important it was. Come the weekends, or to be honest weekday evenings as well, if the opportunity to go out was there, I’d be out, which would normally involve drinking, and of course the disruption of any schedule.

Even in the periods when I managed to keep a routine, the times would still come when something would trigger an episode and everything would fall apart. That of course is still something I’m looking into, keeping an eye out for triggers. For now though, or at least in the last three days, I’ve managed to force myself back into my preferred sleep/wake cycle, which is being in bed by 10, up at 6am. It’s just something that I’ve worked out over time suits me best.

It really is annoying to think that even on a Friday and Saturday I’ll have to stick to such a routine, but disruptions really can and obviously have many times, triggered an adverse reaction. Bearing in mind just how horrible and long lasting these can be, it is much better to stick to this and when I have my appointment with my psychiatrist discuss these things further. It will be good to discuss these issues with someone in person.

A quick addition to say it’s four days now, Friday and Saturday were OK, I’m feeling pretty good at the moment. I have to work on the social aspect though, I’m not sociable at the moment for a number of reasons, but we’ll discuss that another time.

Oh and also that I now write my posts early in the morning and schedule them to posted later on in case it seems weird that I’m writing about sleeping patterns and my posts go up during the night. 

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