A key strategy for coping with Bi Polar Disorder is to understand and recognise early warning signs. I have been fortunate to attend self-management courses where delegates examine their symptoms and share experiences after which they are more aware of mood changes and how to spot when a depressive episode or a period of mania or hypomania is likely to occur. On any course, the stress is on sleep as the ‘key’ to staying well. Yet this is the first to go during a ‘wobble’. So what can you do?
If I sleep deeply for a reasonable 7-8 hours, wake refreshed and feel dopey for the first 10-15 minutes I am usually well. However, periods of disturbed nights or lack of sleep can signal the possibility of a manic episode. For me two nights of not sleeping or only getting 1-2 hours of shallow sleep is a warning sign of impending illness. When this happened two years ago, six months after an episodic illness I phoned the mental health line on my care plan and was phoned back by a Clinical Nurse. Unlike GPs, these professionals ask the right questions, establish what has been happening in the previous few weeks and fax my practice requesting a prescription or an increase in medication.
A simple sleeping pill has worked in the past – over a week a new sleeping routine is established. In the second week I try the occasional night without a tablet or break the tabs in half. I know that to take Zopiclone for more than 14 days could make me dependent. This dependency can be reversed but it can take several days to begin to drop off to sleep naturally.
The heart warming response of the Clinical Nurse makes me feel better immediately. Don’t feel guilty. You have an illness. Those with mental illness need to grasp that the illness is not going to go away. Bi polar is part of your make up forever once it has manifested itself. Being pro-active and getting help early when the EWS appear actually makes me feel stronger. The hardest thing to do when mentally ‘down’ is to take action or get up and out of the house to do something active. But once I have taken a positive action, I immediately begin to feel better.
One of my own Early Warning Signs for a bi-polar depression is excessive sleeping. Sleeping ten to twelve hours is a sign that I have perhaps overworked, skipped some self care or have not been regular with my sleep pattern. With all aspects of bi polar, the brain tries to balance itself and thus produces symptoms. When the brain has been over stretched, stressed or overworked its response is to shut down. In the past I have panicked when I have felt slow, lethargic and unable to function fully. Now I have changed my attitude. I view this ‘down’ time as the brain taking a rest. I allow myself to chill out and step away from tasks which may have become overwhelming. It is at these times the energy, I usually apply to my writing, seems absent.
At an author’s talk recently the speaker said there was no such thing as writer’s block. For someone with bi polar this view is a misnomer. There definitely is such an anomaly. Writing, usually a full flow activity, becomes difficult and the words will not come. Now I do not force myself. I sit back and find something to read. After all, reading good authors and excellent writing is one of the necessary tasks of a writer. Yet it is the writing which is neglected in the descent into the low period. Also, in a hypo-mania phase (less dangerous than full mania) I tend to write excessively but ignore the reading and editing of my work. When the ‘block’ sets in, editing past work always inspires me. This has a profound effect on my self esteem as I cannot believe I have written what is on the screen. Even I think it is wonderful stuff. One symptom of depression is the feeling of worthlessness and the idea that any writing you have completed is ‘rubbish’. This can hold you back from furthering your work but it is necessary to balance the mood to avoid the mistakes and embarrassments that accompany mania with the inflated self esteem and lack of judgement so typical of that phase. We all need to be confident and push ourselves and the difficult part for a bi polar writer, artist or teacher – or any other professional – is identifying what is good in the mass of detritus generated during mania. Writing uses the sub-conscious and removes the negative mental chatter which can affect sleep.
Reading is healing and can relax us at bedtime. This is not only with self-help books although these can take your mind off your apparent problems. Reading a novel takes us into another world. When I am reading, I jot down words used by another author – even phrases – and promise I will use them in the future. Sometimes I use the word in a phrase or sentence of my own which I can apply later to one of my many WIPs (Work In Progress). My notebooks are the gold dust and when I am back on the roller coaster I will browse the notebook and find useful, pertinent phrases that I have put in my wonderful logs.
Excessive sleeping combines with low mood to prevent pleasurable activity. Sleeping late leaves little time in the day and low periods are usually accompanied by disorganisation, poor mental functioning, lack of procedural memory and much more. All this contributes to a day which is less productive. Often the only free time is late evening when the slow, lethargic body has completed tasks that, in better times, are carried out in a couple of hours per morning.
I usually accept the excessive sleeping with the idea that I need the rest but once I feel enough rest has been achieved I aim for better habits and a return to routine. I set the alarm, often late at first, say 9am and then move it earlier each day. Sometimes I have to force myself to get up but I allow myself to go back to bed with a tray of breakfast, turn on the tv and have my notebook ready. The desire to write returns and I begin to take my laptop back to bed. I don’t chastise myself about getting up late as I am, after all, doing some writing, which is my work.
An important task for a bi polar sufferer is to monitor the changes in habits and mood and tinker with a few things a day that may contribute to poor sleep. The following can help.
- Treat yourself …. to nice food, healthy snacks, breakfast in bed.
- Social interaction helps sleep so keep up with friends – keep a diary and note periods of more than a couple of days when you have isolated yourself
- Speak to family. There is no need to burden them. They will know from the sound of your voice how you are feeling.
- Use social media sensibly – scroll through posts on the newsfeed but resist the urge to click on an advert. Ignore (deliberately fail to click like) posts which you find unhelpful. Facebook remembers your likes and pushes those posts higher up the newsfeed. Is someone’s post is making you feel less worthy continue to scroll to find a happier one.
- Do not comment on social media when low and DEFINITELY NOT when manic
- Don’t worry if you feel you have nothing worth saying. Listen to others and try to concentrate. Listening is probably something you have not done when in a higher mood and lack of concentration in depression also affects listening skills
- Go to bed earlier and read.
- Take a herbal remedy, make a milk drink.
- Avoid watching the news in the evening
- keep a sleep diary for later reference
There is so much more you can do to alleviate the symptoms and terrible repercussions of disturbed sleep patterns in mental illness so I hope you will follow my blog and find something useful.
Disclaimer: This post is not intended to be a substitute for paying a visit to your GP and is definitely not a substitute for medication. Medication is an integral and important part of the treatment of bi polar disorder as is regular consultations with the medical profession. You should always take the prescribed tablets and report serious changes in behaviour to your doctor. But self help can be a precursor to a doctor’s appointment and I will cover this in a later post.
About me: I was diagnosed with Bi Polar Disorder in April 1989 after a high dose of steroids for inflammatory bowel disease induced mania. Since then, I have had long spells of ‘wellness’ and my most vulnerable time is when I am physically ill. Bladder infections affect my mood and a few years ago collapsed kidneys brought on a manic episode. I have attended Living With Bi-Polar courses in 2007 and 2014 and am so grateful that these courses are available. They are provided on joint initiatives by Social Services, local Mental Health services and the NHS. I am a writer and have a driven personality which allows me to pursue my long held dreams of being published. My key strategies for staying well are ensuring I get ample sleep, a good diet, exercise, fresh air, zumba classes and, the most helpful – yoga and mindfulness. I aim for quality experiences and try to have short breaks or budget holidays to look forward to.