When you lie down,
you will not be afraid;
when you lie down,
your sleep will be sweet.
-Proverbs 3:24 (NIV)
A few weeks ago, I posted a blog about my sleep patterns and how important my sleep was to me. I was met with a number of responses and emails from several readers who were having problems getting enough sleep at all, despite their best efforts.
According to the National Institutes of Health, sleep disturbance is a core symptom of bipolar disorder. The diagnostic criteria for bipolar disorder indicate that during manic episodes there may be a reduced need for sleep and during episodes of depression, insomnia or hypersomnia can be experienced nearly every day (American Psychiatric Association, 2000).
What’s at stake for an individual with Bipolar Disorder or disorder who is struggling with sleep? The National Institutes of Health cites seven key reasons why sleep disturbance in Bipolar Disorder matters:
- Sleep Disturbance Impairs Quality of Life
- Sleep Disturbance Contributes to Relapse
- Sleep Is Critical for Mood Regulation
- Sleep Is Important for Cognitive Functioning
- Sleep Impacts Health
- Sleep Deprivation Is Associated With Substance Use
- Sleep Deprivation Contributes to Impulsivity and Risk Taking
How much sleep should I get each night?
Adults should get between seven to nine hours of sleep each night.
Generally speaking, when I’m manic, I get more sleep, even enforcing a mandatory bed-rest period for two to three days. When depressed, I aim to sleep less, with a focus on getting up early.
Obviously, sleep quality is core to the disease, so what’s to be done when sleep eludes an individual who is working so hard to stay well?
Uncovering Sleep Issues
- Attempt to discover all the factors that are affecting your sleep.
- Discuss your sleep issues with your doctor right away.
- Keep a sleep diary. Include:
- How long it takes to go to sleep;
- How many times you wake up during the night;
- How long you sleep all night;
- When you take medication or use caffeine, alcohol, or nicotine;
- When you exercise and for how long.
- Certain bipolar medications may affect sleep as a side effect, by disrupting the sleep-wake cycle. Discuss this with your doctor.
- Consider any other drugs or medical conditions that may be affecting your sleep (arthritis, migraines, or a back injury).
- Are you using alcohol, medical marijuana or other pills/street drugs to manage your moods/self-medicate? These substances will interfere with your body’s natural sleep cycle.
Take steps to restore sleep
- Establish consistent sleep and wake schedules, even on the weekend. This will support your circadian rhythm to get in sync with a normal schedule.
- Limit daytime naps, if not sleeping well at night.
- Use your bedroom only for sleep and sex.
- Avoid electronics in the bedroom, including smartphones and ipads. (They are proven to stimulate the brain and keep you awake.) Keep them charging away from your bed, preferably in another room.
- Adjust medication dosage times with the assistance of your doctor (do not take stimulating drugs at night).
- Eliminate alcohol, caffeine, heavy or spicy foods late in the day.
- Keep the bedroom as dark and quiet as possible and maintain a temperature that is not too hot or cold. Use fans, heaters, blinds, earplugs, or sleep masks, as needed.
- Talk with your partner about ways to minimize snoring or other sleep habits that may be affecting your sleep.
- Exercise regularly, but not too late in the day.
- Try visualization and other relaxation techniques.
- If hungry, eat a snack an hour before sleeping of complex carbs and protein (a turkey sandwich on whole grain bread with cheese).
What else can be affecting the quality of my sleep?
Water and Hydration Are your brain and body well hydrated? According to Dr. Joseph Cilona, dehydration can have very serious neurologic effects and disrupt cognitive functioning, even while sleeping.
Sunlight There’s wisdom to mom’s urging when we were young to go outside and play. Many of us are stapled to our desks or locked in fluorescent offices during daylight hours and aren’t getting to see the sun on a consistent basis.
Spending time daily in the sun also helps to set and support the body’s natural circadian rhythm, which are “physical, mental and behavioral changes that follow a roughly 24-hour cycle, responding primarily to light and darkness in an organism’s environment. They are found in most living things, including animals, plants and many tiny microbes (National Institutes of Health).”
A healthy circadian rhythm with help you to sleep regularly at night, but it is critical to go to bed at roughly the same time each evening and wake at approximately the same time each morning.
Exercise Are you getting enough exercise (or experiencing enough activity), so that your body is tired at the end of the day? If your 9-5 is spent in a chair or glued to a sofa, it may be difficult to force your body to rest after such a sedentary day. You may need to increase your daily activity to include a 30 minute walk mid-day, or a morning workout could do the trick.
Relationships Are your relationships stressing you out and adding unnecessary anxiety and angst during the evening hours? If so, it’s time to rebalance the relationship(s). Relationships should bring us joy and contentment, not distress and lost sleep. If you are tossing and turning over a relationship in your life, it’s time to address the issues causing harm and make some immediate changes.
Quality Calories Are you eating whole, nutritionally dense foods that sustain you throughout the evening and night? Or are you a sugar junkie who wakes up with a carb craving around 1am and indulges nightly? That midnight snack could be causing your body multiple problems. First, by training your body to wake each evening for a snack, you are interrupting your body’s natural circadian rhythm and natural tendency to sleep all night. Second, depending on your snack of choice, you are spiking your blood sugar levels at precisely the time they should be stable, which triggers a whole set of chemical reactions that are best reserved for daytime hours. Third, you’ll be experiencing weight gain which doesn’t do your body or your self-esteem any favors.
If you have problems sleeping, your first step should be to discuss the issue with your doctor. Don’t attempt to handle the problem on your own or self-medicate, as many over the counter sleep aids may exacerbate bipolar symptoms or cause secondary problems. See a doctor, be patient, and be prepared to live (and sleep) according to a firm schedule that will reset your body’s circadian rhythm to support your body in setting regular sleep hours.