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Sleep changes can affect bipolar symptoms, but healthy routines can support circadian rhythm and mood stability.
Do you have something in life you’d like to leave behind, but life events continue to trigger a return to that horrible place?
My senior year in college is burned in my memory like a memorial alongside a road where a tragic accident occurred. During that year, I had my first battle with bipolar depression, which lasted nine months, followed by three months of full-blown mania.
Unfortunately, as so often happens, years of suffering passed before I received a correct diagnosis of bipolar disorder and treatment started.
For a person living with bipolar, keeping a healthy sleep schedule usually means going to bed and waking up at the same time every day, even on weekends. Getting enough steady sleep helps keep your mood stable. In practice, this means planning your day around a regular sleep routine instead of trying to make up for lost sleep after a few rough nights. Many adults with bipolar can help keep their mood stable by getting 6.5 to 8.5 hours of uninterrupted sleep each night.
One of the hallmarks of that period in my life, and a challenge that long continued, was a profound change in the quality of my sleep. Disturbed sleep became as problematic as the mood disorder itself.
Understanding Sleep Patterns and Bipolar Mood Shifts
During my first depressive phase — nine months of an unrelenting state of gloom and desperation — I slept up to 18 hours a day. But, because the sleep was so troubled, I would awaken exhausted and unable to concentrate.
When my mood shifted to a manic phase, my sleep pattern shifted, as well. I slept little, a meager two to three hours per night, at most, and then awoke full of chaotic, unfocused, manic energy.
Even over the years, good, sound, natural sleep has been a cherished and sometimes difficult achievement. In fact, one time — no doubt due to sleep deprivation — I fell asleep while driving and totaled my car. What a wake-up call that was! I knew then that I had to start taking sleep seriously.
Sound sleep is a serious matter for all of us. So, I want to give you something to sleep on, so to speak — besides, of course, a good mattress. Let’s study the issue of sleep by asking four important questions.
1. How Much Sleep Do You Need With Bipolar Disorder?
There’s no single sleep target that fits every person living with bipolar disorder. For many adults, research suggests that roughly 6.5 to 8.5 hours of sleep may be a useful range, but the bigger goal is to keep sleep predictable from night to night.
That means paying attention not only to how long you sleep, but also to when you go to bed and when you wake up. A steady sleep pattern can help support the body’s internal clock, while sudden changes in sleep — whether too little or too much — may be a sign that your mood is shifting.
For adults in general, the Centers for Disease Control and Prevention (CDC) recommends seven or more hours of sleep per night. But with bipolar disorder, the goal is not just to meet a general sleep recommendation. It is to build a regular sleep-wake rhythm that helps protect your mood, energy, and daily functioning.
When you miss sleep, it can be tempting to “make up for it” by sleeping much later the next day. But frequent shifts in bedtime and wake-up time can make your sleep pattern less stable. Over time, that instability may make it harder for your body to stay on a consistent rhythm.
2. What Does Sleep Do for Your Circadian Rhythm?
People once thought of sleep as a passive, dormant part of our daily lives. But we now understand that quality sleep helps maintain sound physical and mental health, including the body’s daily circadian rhythms that influence mood, energy, and alertness.
Sleep is one of the strongest signals for your circadian rhythm — your internal body clock. When your sleep and wake times stay consistent, that rhythm has a better chance of staying steady, which can be especially important for people living with bipolar disorder.
For one, sleep at night helps repair neurons used during the day, according to MEDtube Science.
Furthermore, deep sleep really is “beauty sleep” because it slows the breakdown of proteins, the building blocks for cell growth. Sleep also helps the body conserve energy — and other necessary resources — so the immune system can effectively mount its attacks.
A good night’s sleep helps ensure a properly functioning nervous system. Poor or inadequate sleep can lead to drowsiness, poor concentration, and impaired memory.
3. How Are Sleep and Bipolar Disorder Connected?
The amount of sleep a person gets strongly influences bipolar symptoms. Disrupted sleep can trigger episodes of mania and generate agitation and hyperactivity. Extreme sleep deprivation can even lead to a psychotic state of paranoia or cause hallucinations, both of which are dangerous and require help immediately.
When measured on a driving simulator, sleep-deprived people performed as badly, or worse, than those who were intoxicated. In a study published in BMC Public Health, researchers found that people’s sleep-deprived mean reaction times were slower. Plus, lateral control of the vehicle was reduced.
Also, sleep deprivation magnifies the effects of drinking alcohol — which can be a concern for some people living with bipolar disorder — making for an even riskier situation.
Getting solid, deep sleep positively impacts the brain’s capacity to regulate emotions, support decision-making, and govern social interactions. Yet this type of sleep is often impaired when bipolar disorder is in the picture.
If you’re living with bipolar, it is especially important to make sure that you’re getting the most productive sleep possible. The better you manage your sleep schedule, the more support you may have for managing your mood.
4. What Can You Do to Improve Your Sleep?
When sleep troubles persist, taking a sleeping pill does not have to be the first resort. Here are some tips to increase the likelihood of getting a good night’s rest:
Set a consistent wake time. To establish a consistent sleep pattern, try waking up at the same time every day (including weekends). A regular wake time gives your circadian rhythm a clear anchor, and your bedtime can gradually adjust based on how much sleep your body needs. Once you’ve fine-tuned your sleep schedule, stick to your routine as closely as possible.
Time physical activity thoughtfully. Try to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep, but timing matters. Vigorous exercise too close to bedtime may make it harder for your body to wind down. For maximum benefit, try to exercise about five to six hours before going to bed. Plus, exercise produces endorphins, which are good for brain health, too, according to Mayo Clinic.
Avoid caffeine, nicotine, and alcohol before bed. Consuming stimulants, such as caffeine or chocolate, in the evening can keep you awake. Similarly, smoking can lead to lighter, more disrupted sleep. And drinking alcohol near bedtime can interrupt and fragment sleep, too. Because caffeine, nicotine, and alcohol can all interfere with the body’s sleep-wake rhythm, timing and consistency matter.
Create a predictable evening routine. Try to unwind early and deal with life’s distractions well before bedtime. A consistent nighttime routine can signal to your body and mind that the day is ending and sleep is approaching. This routine might include a warm bath, quiet music, dimmer lighting, or another calming activity that you repeat around the same time each night.
Use morning light to help reset your body clock. If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body’s internal biological clock to reset itself each day. According to research, high levels of morning sunlight can reduce depression, help you fall asleep faster, and improve overall sleep quality.
Keep daily timing cues as steady as possible. The body’s internal clock responds not only to light and darkness, but also to everyday rhythms such as meals, work, social activity, exercise, medication routines, and wind-down time. Keeping these cues consistent from day-to-day can help reinforce a more predictable sleep-wake cycle.
Reduce bright light and stimulation at night. In the evening, shift your environment toward signals that tell your brain it is time to wind down. This may include dimming lights, limiting stimulating activities, and avoiding bright screens close to bedtime. The goal is not simply to “try harder” to sleep, but to give your circadian rhythm clearer daytime and nighttime signals.
Talk with your doctor about medication timing and side effects. If you’re dealing with bipolar disorder, chances are that your doctor may have you taking one or more medications. Some medications may have side effects that cause insomnia or drowsiness. It’s important to discuss your sleep patterns, medication timing, and any changes in sleep with your doctor. Do not adjust medication timing or dosage without medical guidance.
Take additional steps if sleep problems persist. If you have trouble falling asleep night after night, or if you always feel tired the next day, you may benefit from seeing a sleep specialist. In difficult cases, a doctor may prescribe a sleep agent or other treatment. Fortunately, most sleep disorders can be treated effectively. The key is to take ongoing sleep disruption seriously, especially when living with bipolar disorder.
There’s an old joke about a nurse awakening a patient to take a sleeping pill. However, sleep problems are no joke. Lack of good sleep can cause confusion and frustration during the day, and diminish a person’s overall mental alertness and well-being.
Better circadian rhythm management — especially when someone has bipolar disorder — can support steadier sleep, mood, energy, and overall quality of life. Now, maybe you can sleep on that!
Editor’s note: Longtime columnist and mental health advocate Stephen Propst passed away in 2022, yet his enduring words of wisdom continue to resonate. We share them here to offer support and insight to the bipolar community.
Editorial Sources and Fact-Checking
UPDATED: Printed as “Something to Sleep On,” Spring 2007
