Can Keeping a Routine Help Control Bipolar Symptoms?

Bipolar disorder is characterized by extreme mood swings from emotional highs (mania) to emotional lows (depression). Most people who have bipolar disorder take daily mood-stabilizing medicines to control their symptoms. But medicine isn't the only solution. Some studies show that a daily routine can help control bipolar symptoms.

Researchers from the University of Pittsburgh School of Medicine reported that bipolar patients fared better when their treatment stressed the importance of establishing daily routines for things like sleeping and eating.

"We see patients with bipolar disorder as having exquisitely sensitive and fragile body clocks," said researcher Ellen Frank, PhD. "They need to be more attentive than the rest of us to things like when they get up and go to bed and when they eat their meals."

Other studies conducted have also indicated that bipolar disorder sufferers are more sensitive to when their circadian rhythms are disrupted or off balance.

"Bipolar people don't do well with lots of changes," says Michael First, MD, a professor of clinical psychiatry at Columbia University and attending psychiatrist at NewYork-Presbyterian Hospital. Therefore keeping a consistent schedule can reduce minor mood swings that typically lead to more severe episodes of mania.

Coping with bipolar disorder isn't easy, but understanding what causes mood swings can be the first step in coping with the ups and downs of the disorder. One of the best ways to track this is by sticking to a routine.

Keeping Your Daily Routine

Make sure that your sleep schedule is as regular as possible. Setting a regular sleep and wake time is probably the most important thing you can do to for yourself if you have bipolar disorder. "Overwhelming data shows that sleep disruption is the surest and fastest way to induce a manic episode," says Dr. Charles Raison, psychiatrist at Emory University Medical School.

Create a bedtime ritual an hour or two before planning to fall asleep each night. Relax before bed by listening to soothing music, reading, or taking a warm bath. "It's common for people with bipolar disorder to stay up late watching movies, playing video games, or surfing the Internet, which can make mood swings worse," says Carrie Bearden, PhD, a bipolar disorder expert and associate professor of psychology and behavioral sciences at UCLA.

Take medications at the same time every day. This is very important. Your body will respond to a consistent schedule.

Set a regular time to exercise. Walking is a great choice as it gets you out in the fresh air. Consider a morning walk before you get your workday started. Start out by taking short, 10-15 minute walks, and eventually increase these to 20-30 minute walks.

Set regular times for meals and eat a healthy, balanced diet. Avoid too much caffeine, sugar and alcohol. Especially avoid caffeine after lunchtime.

Set regular work hours. If you are working a job that requires unpredictable hours and lots of travel, you may want to reconsider.

Limit travel across time zones. We all know about jet lag, but for people with bipolar disorder the circadian disruption that manifests as jet lag can be quite dangerous.

Do errands at the same time every day. Pick a time of consistent time of day when you'll go to the bank, post office, supermarket, etc.

Dedicate a regular time for relaxation or stress-relieving hobby. This could include yoga, meditation, music, painting, singing, etc.

Pick a regular time to write in your mood journal. A journal where you can record how you feel each day will help you recognize patterns in your mood and identify early warning signs. At about the same time every day, ask yourself, "How did I feel today?" Use a scale from 0 (depressed) to 10 (manic), with 5 being normal, and give yourself a daily score. If you have any new or different symptoms, write them down. Also note anything stressful or unusual that disrupted your routine.

Planning your day around a fairly predictable routine can help you manage your moods and ultimately your illness. With a routine you can recognize when you haven't been sleeping well or have been forgetting to take your medication--and you'll be able to adjust your routine accordingly. You might also discover certain things that trigger a change in your mood and start to see patterns emerging. This will give you the power to avoid those things in the future.

Sources

Boyles, S. Daily Routine May Help Bipolar Disorder. WebMd Health News. September 8, 2005. http://www.webmd.com/bipolar-disorder/news/20050908/daily-routine-may-help-bipolar-disorder. Retrieved November 11, 2009.

Can Keeping a Routine Help Control Bipolar Symptoms? Expert Q & A, CNNHealth.com. September 29, 2009. http://www.cnn.com/2009/HEALTH/expert.q.a/09/29/bipolar.symptoms.routine.raison/index.html. Retrieved November 11, 2009.

Curtis, J. Van Houten, S. (ed.) Bipolar Disorder: Preventing Manic Episodes. Reviewed by Lisa S. Weinstock, M.D. and Kathleen Romito, M.D.  Healthwise on blueshieldca.com. Blue Shield of California. March 14, 2008.

Sheehan, J. Coping With Bipolar Mood Swings. EverydayHealth.com. November 17, 2008.