Improving Insomnia Through Lifestyle

Insomnia frequently goes hand-in-hand with bipolar and other mental illnesses

This is the first instalment of a series about sleep hygiene and mental illness. Stay tuned for the rest of the posts!

Since I was diagnosed with bipolar disorder nearly ten years ago, I’ve tried all manner of tips and tricks to reduce my need for medication and therapy. It’s not that I’m anti-medication, but antipsychotics and antidepressants are powerful tools that can have both immediate and long-term side effects. Many of the medications on the market are new enough that no one really knows what they may do to the human body if taken for decades on end, while others are so toxic to the body that they require constant monitoring, like lithium.

This is why I firmly believe that all of us, no matter our specific symptoms, should strive to take the lowest possible dose of the fewest possible medications. Another benefit of this is that this leaves plenty of “wiggle room” should symptoms worsen and dosages need to be increased, as your body remains responsive to stronger dosages. It also allows for other medications to be substituted or added in should your current medication stop working, a very common problem in most mental illnesses.

I am frustrated by the fact that many psychiatrists don’t take the time to properly educate bipolar people on non-pharmacological interventions. Most of us are left to find these things out on our own through research or talking to other mentally ill people, and poring through article after article to glean such wisdom can be exhausting. That’s why I hope that listing out what has helped for me, along with why it works, will help you develop a battle plan for managing your bipolar, letting you try out a number of approaches and figuring out what works for you.

There are, of course, plenty of lists that discuss what you can do to improve your symptoms, but most of them do not provide both scientific and personal descriptions of the effects. This series is not an exhaustive list of interventions, nor is it meant to replace a conversation with your doctor about what might work for you. This is especially true if you are considering adding supplements to your routine (which I highly suggest you do!), as some may affect your current medication regimen.

Sleep: essential for well-being

Research suggests that bipolar disorder is strongly tied to sleep disturbances, with some even claiming that bipolar is primarily a sleep disorder rather than a mood disorder. Anyone, bipolar or not, who has experienced insomnia will tell you that they just don’t feel well after a few nights of bad sleep: crabby, distracted, and prone to mistakes.

Sleep is one of the most critical components to good health, if not the absolute most. Periods of deep, restorative sleep allow the brain and body opportunities to process memories, replenish energy stores, and work on all those “background programs” like digestion, injury repair, and hormone balance.

Think of sleep like your body’s version of closing down shop after a shift: counting down the cash register, doing morning prep work, sweeping and cleaning. If you don’t attend to these tasks, you’re going to be less productive the next day because you need to catch up on all these chores in addition to your normal to-do list. Your body is the same: when it has to catch up on digestion, healing, memory processing, and the like while you’re up and active, you don’t have as much energy and focus.

Because of these reasons and more, poor sleep is connected to obesity, hormonal imbalances, cardiovascular impairment, and worse performance on cognitive and physical tasks. It’s no wonder that sleep is such a critical part of wellbeing for bipolar people, as we are vulnerable to many of these conditions because of the medications necessary to keep us stable.

Good routines for good sleep

Much of what we do during the day impacts how well we sleep. This is why we need to look carefully at what we are doing throughout the day and how it might affect us when we’re finally ready to hit the hay. The brain thrives on routine, and knowing what to expect throughout the day will help us reduce our mental load, which can allow us to rest easier at night.

Try to go to sleep and get up around the same time every day

Doing this will help to stabilize your circadian rhythm, and you probably find yourself getting sleepy around bedtime after a few weeks of a consistent routine.

I am usually someone who can sleep in until noon if you let me, but recently I’ve started to make myself wake up at a “normal” time, like 8 am, and now I find it difficult to stay in bed much later than that. Yes, it absolutely sucks and I’m a total zombie for about an hour. I would much rather snuggle back into my bed and drift off for the rest of the day, especially as I struggle with chronic pain in addition to my bipolar. But as much as it sucks, I do find that staying regular with waking up helps me get to sleep in the evenings.

I have also found that I start to wind down around midnight or 11:30 pm since I’ve begun to get up earlier. I actually don’t even want to be awake later anymore: the impulse to mess around and watch TV until the wee hours of the morning has diminished a lot.

This is something I don’t think we discuss very much: how insomnia can be a self-perpetuating cycle. You can’t fall asleep, so to keep yourself occupied you mess around on the computer or watch a movie, and you think this helps you eventually wind down. Then, the next night, you think you won’t be able to sleep, so you don’t even try to go to sleep and instead read a book, play a game, watch TV, or whatever. This mental stimulation then prevents you from feeling sleepy and makes it harder to fall asleep even when you eventually decide to try to turn in.

This is why it’s so important to maintain a steady routine and get yourself to bed at a reasonable time. For me, at least, it’s the waking up early that really makes sure that I go to sleep at a normal time, so even if you stayed up late last night, push yourself to get up as you normally would. Yes, even on weekends!

Schedule extra time for sleep

Allow yourself some padding by making your bedtime slightly earlier than when you need to fall asleep. Never assume you’re going to be out like a light the instant that your head hits the pillow unless you take a sedating medication. Since our brains are working so hard to keep us steady, they take longer to cool down as well.

If you’ve found you need seven hours to feel rested, go to bed eight hours before you need to be up. I personally need a full eight to nine hours of sleep, so if I need to be up by 8am, I will make sure I go to bed at 10:30 or 11pm.

This strategy will help prevent sleep deprivation if you end up tossing and turning a bit, and even if you fall asleep right away, you’re not doing any harm as long as you aren’t getting drastically more sleep than you would need.

Take your medication at the same time every morning and night

Many of us have medications or supplements we take in both the morning and evening. It’s important to take these at the same time every day so that your body “runs out” of the morning medication before bedtime, and the evening medication kicks in at a consistent time.

Even if you have only one or two medications you need to take, I recommend that you keep them in a pill counter, as this gives you a visual reminder of whether or not you’ve taken your medication. I keep my pill counter and my medications on a table right next to my bedroom door, with a cup of water handy, so that I remember to take them before I brush my teeth in the morning and evening.

While most evening medications say to take them at bedtime, unless you’re on a medication with a heavy sedative effect like Seroquel or Trazodone, you will want to take them a bit earlier than that so they have time to kick in before you fall asleep.

Also, if you find yourself newly drowsy in the morning or alert in the evening, you may have to switch when you take a given medication, as many medications can make you either alert or sleepy, like Cymbalta. Just be sure that you take them at the same time each day and don’t flip back and forth between mornings and evenings.

Limit your caffeine intake after about 3pm

If you’re a huge coffee drinker, switch to decaf in the afternoon; if you like tea, there are decaf versions of most teas, or you can find a herbal version that you like. For soda drinkers, they sell flavor enhancers for water that are caffeine-free but still taste like your favorite treat.

Avoid alcohol

This is just general good advice for those of us with bipolar, especially as we are quite vulnerable to addiction and alcohol can have dangerous interactions with medication. While it might be tempting to have a nightcap because alcohol is a depressant, alcohol actually reduces quality of sleep.

Now, I’m not saying you can’t have the occasional tipple; we all do, even if we don’t tell our doctors for fear of shaming! Just make sure to keep it within moderation. I try to only drink on Fridays and Saturdays, and I limit myself to no more than three beers.

If you find that you simply cannot fall asleep without a drink, this is a warning sign that you’re becoming drug-dependent and you should bring it up with your psychiatrist.

Try to exercise every day

Exercise has remarkable bodily benefits, but the reason it’s so important for sleep is that it produces norepinephrine and serotonin, the chemicals involved in sleep, and ones which the bipolar brain struggles to produce consistently.

We often ignore the fact that exercise doesn’t have to be done in a gym. Cardio simply means getting your heart rate up higher than its resting beats per minute, while strength training is just forcing your muscles to work more than they do at rest.

Most of my cardio comes from walking my dogs; I make sure to walk them at a brisk pace so that I’m getting my heart rate up at least a little bit. Another cardio I particularly like is Nordic Walking, which uses special poles to help distribute strain throughout the body. One of the benefits of this is that you get a harder workout without feeling like you’re working harder. I will do Nordic Walking for only half an hour at a comfortable pace, only to find that I’m dripping in sweat when I get home!

A great benefit of these two exercises is that they allow you to get outside and enjoy some sunshine. Not only is this great for your mental health, but it also enables you to synchronize your internal clock with the actual time of day. This is especially important for those of us who live further away from the equator, as sunrise and sunset differ drastically throughout the year.

For strength training, body weight exercises are an excellent way to improve muscle tone without the self-consciousness that might come from the gym. You can also customize your exercise for your level of fitness. I can’t hold a plank for more than ten seconds, but I can hold a modified plank for much longer. You can also try wall push-ups if you can’t do normal push-ups. Remember, even the slightest bit of exercise is better than nothing, so never feel bad that you can’t do the typical workout.

Some people suggest that you shouldn’t exercise close to bedtime, but I’ve actually found that I sleep better when I do a bit of exercise in the evening and the morning. I walk my dogs every day on my lunch break (the joys of working from home!), then I will either go Nordic Walking or do some light yoga, depending on my energy and pain levels that day. This may not hold true for you, so try a few combinations.

Don’t take afternoon naps

I know, this sounds truly cruel, especially because bipolar can cause daytime sleepiness. However, as enjoyable as that nap might be, it will actually make it more difficult to get to sleep later on. If you have gotten up for the day, try to stay up until bedtime.

If you find yourself getting so sleepy that you can hardly stay awake, try drinking a glass of cold water, doing some jumping jacks, or going for a brisk walk. I have also heard that B12 drinks can give you a little energy boost without the insomnia-inducing effects of caffeine, though I have yet to try them.

Allow yourself a sleepy cheat day

What?! I just told you not to take afternoon naps and to get up at the same time every day!

Yes, this is true, but bipolar disorder takes up a lot of processing power in our brains. Even if we don’t feel it, our mind is working harder than usual to maintain stability and assess our current mood. We also have more difficulty with organization and time management, so functioning at a “normal” level drains us. This means that we will be down for the count faster than a neurotypical person; even with a full night’s sleep, we might still be serious fatigued just from getting through the week.

At least once a week, schedule some extra time for yourself to rest, even if you don’t actually sleep. Make sure that your family and friends know that this is your time and that if they need something, they either need to wait or make alternate arrangements. If you have children, schedule babysitting for them during this period or ask a loved one to take them out for a play date. And don’t take this is as an opportunity to catch up on responsibilities like housework, either. This is strictly time to do something far more important: recharging your batteries and relaxing your mind.

Don’t feel guilty for taking this time because it allows you to be more present throughout the week. Humans aren’t machines and we weren’t designed to be on the go 24/7; this is especially true for bipolar individuals because we simply don’t have the mental stamina of other people. You are preventing more serious problems for yourself and others by allowing yourself a break and checking in with yourself.

If you are like me, with a Border Collie brain, it can be very hard to switch off and allow yourself the opportunity to be ‘lazy.’ That’s why it’s even more important to consciously switch off — you won’t otherwise. Consider this a pivotal business meeting that’s essential for running your life, or like a weekly doctor’s appointment with your primary care provider, you.

Maybe you don’t want to sleep because you don’t want to mess up your fragile sleep schedule; I totally understand. The important thing here is allowing yourself a break from thinking, planning, and doing. Getting yourself into that calm state of mind will improve your quality of sleep even if it’s of the same quantity. Here’s some low-energy things you can do rather than sleep:

• Meditate
• Watch mindless TV
• Read a trashy novel that requires no thinking
• Do a repetitive craft like knitting, crocheting, sewing, or coloring
• Give yourself a facial and deep condition your hair
• Cuddle with your pet

I find that knitting is a great relaxing activity for me because then I still feel like I’m being productive even though it’s not monetarily rewarding.

You might find it difficult to unwind at home because there’s so much to do, but there are calming things you can do outside of the home as well:

• Take a slow and casual walk in the park
• Ride the bus or train while listening to music
• Go on a long drive
• Window shop at the mall with your favorite drink
• Browse at the library and pick out some books for later
• Visit a botanical garden or art museum

All of these are great ways to care for yourself in the same way you care for others. You can also switch it up and spend your me-time sleeping one week and doing something low-energy the next.

The most important thing is that you spend this time NOT thinking, NOT doing anything productive, and NOT stressing.

Pay attention to your sleep cycles

For us, more than anyone else, our relationship to sleep is a bellwether for what’s going on in our minds; as said before, some believe that bipolar disorder is a sleep disorder masquerading as a mood problem, so any change in sleep patterns can signal a nosedive.

If you find that you simply cannot sleep no matter what you do, you need to discuss this with your psychiatrist as it can be one of the first signs of mania. If you have a low mood and you’re always sleepy, this can be a sign of depression.

If you have severe sleep problems, please rule out non-bipolar conditions

A number of other conditions can cause insomnia, such as sleep apnea, and they can be dangerous if not treated. Talk to your psychiatrist or primary care physician about scheduling a sleep study, which is covered by most insurance companies.

I hope this has had some helpful information for you. Even if it didn’t and you do all of these already, it’s always good to reinforce the importance of your good habits. Research suggests that we need to read something three times before we fully assimilate it into our minds, so the more often you read articles like this, the better! Sweet dreams, my friend!

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