Every morning Charita Cole Brown, who was diagnosed with bipolar disorder at the age of 21, wakes up around 7:30 a.m. She prays, meditates on Scripture and centers her mind. She journals (which she also does at night). Then, she showers and dresses for the day.
Routine is vital for everyone’s well-being, but it’s especially essential for individuals with bipolar disorder. “Research shows that having a ‘rhythm’ to our daily and weekly activities promotes a stable mood,” said Cynthia Last, Ph.D, a clinical psychologist who specializes in treating individuals with mood disorders in Boca Raton, Fla.
In fact, there’s an entire evidence-based treatment that helps with setting up structures, systems and routines, which is called interpersonal and social rhythm therapy.
Last suggested scheduling meals at the same times every day, along with other activities, such as: watching a favorite sitcom on Thursday nights, running errands on Saturdays, and attending church on Sundays.
This is what Gabe Howard does. Howard, a writer and speaker who has bipolar disorder, works from the time he wakes up (around 7 a.m.) to 5 p.m. Monday through Friday. After work, he makes dinner. On Sundays, he buys groceries and runs errands. Then from 3 p.m. to 9 p.m., he works on the Psych Central podcast and A Bipolar, A Schizophrenic, and a Podcast. Sometimes, his routine shifts because he has a speaking engagement in the evening.
“I have trouble keeping order in my brain, so keeping order in my life is super reassuring and helpful,” Howard said. “When things go the way they are supposed to go, I feel better.”
In addition to establishing a solid routine, there are other ways that individuals with bipolar disorder can stay well, which you’ll find below. Of course, these strategies are in addition to taking medication every single day and working with a therapist.
Be super consistent with sleep. “One of the most important habits to maintaining mood stability is good sleep hygiene,” said Last, author of the book When Someone You Love is Bipolar: Help and Support for You and Your Partner. That’s because “research has shown that decreased sleep is both a cause and consequence of mania.”
Last noted that good sleep includes four components: going to sleep and waking up at about the same time every day (with no more than one hour difference); setting a bedtime at 11 p.m. or earlier (it’s common to get a second wind after 11 p.m.); sleeping at least 7 hours; and sleeping without interruption.
She also suggested carving out 1 hour to unwind before bed. “During this time avoid anything intellectually, emotionally, or physically stimulating. Instead, take a hot bath or listen to relaxing music.”
Be sure your surroundings are conducive to sleep, with comfortable sheets, pajamas and room temperature.
If you’re a night owl whose current bedtime is way too late, Last suggested moving it by 30 minutes every week.
Take care of your body. “Because bipolar is a bodily illness in the same way that diabetes is a bodily illness, I eat healthily and walk several times each week,” said Brown, author of the book Defying the Verdict: My Bipolar Life. She also plans to return to the pool for low-impact exercise. When moving your body, the key is to find activities that you genuinely enjoy, which might be anything from taking a walk to stretching to dancing.
Have nourishing hobbies. You might worry that routines lead to a boring life. Last encouraged readers to “use your intellectual curiosity or creativity to pursue things that don’t pose risk.” For instance, her clients engage in creative writing, painting, sculpting, and reading. They also learn new things by taking adult education classes or e-courses.
In addition to reading, Karla Dougherty, author of the book Less Than Crazy: Living Fully with Bipolar II, loves writing poetry. It “helps settle my mind and it’s a good outlet for my feelings.”
Do a daily self check-in. Colleen King, LMFT, a Sacramento psychotherapist who has bipolar disorder and specializes in treating the illness, noted that one of the most powerful habits for her and her clients is the “self check-in.”
It’s “a holistic approach to noticing emotional, physical, cognitive, and social well-being. It’s an exercise that can give valuable information about mood state, sleep quality, stress level, physical comfort/discomfort, emotions, daily goals, relationships, wants, and needs, and it empowers you to make the changes you need to take care of yourself.”
According to King, this is how it works: Start by practicing diaphragmatic (belly) breathing for a minute or two, which helps you to focus on your body and feel more relaxed. Think about your mood, sleep, stress level and other factors (see above) in the past 24 hours, along with how you’re feeling right now. Then record your observations in a notebook or app, or tell your support network.
Build in downtime. King noted that this is another essential healthy habit. She stressed the importance of making sure you carve out the time and space to rest and relax “with reduced stimulation.”
Don’t topple your plate. Dougherty stays calm by not scheduling too many things in one day. Because over-scheduling leads her to feel exhausted, irritable and irrational. Usually, she intuitively knows when she has too much on her plate. And she also has kind, supportive people—her husband and friends—to point out when she’s “verging into unsteady territory.” Which is when she slows down for a while.
Of course, everyone is different; one person’s overscheduled and overworked is another’s full and fulfilling life. So it’s vital to know yourself, your limits and your needs.
Find an accountability buddy or tribe. Both Brown and King emphasized enlisting the help of an accountability partner or network for daily support. You also might research a MeetUp group, club, or another organization to find like-minded people, in person or online, King said.
Be kind to yourself. “When you don’t feel well enough or forget to do the task, be kind to yourself and resolve to try again right away,” King said. “There’s no need to wait until next year, next month, or even until next week to begin again.”
Also, make sure you’re acknowledging your successes—no matter how small they might seem. As King said, if you’re in a depressed state, brushing your teeth and taking a shower is successful.
Don’t underestimate the power of small gestures. Healthy habits that make a significant impact can be small. For instance, Dougherty likes to listen to calming music while she works. “My mind is like an old-fashioned aerobics class, thoughts whirling in my head, getting more and more intense. Calming music slows this down.” (So does solitude.)
Take advantage of technology. Today’s apps are great for helping with everything from getting to sleep on time to meditating to moving your body to documenting your mood. Many also include forums with discussions and tips.
For meditation, King’s favorite app is Insight Timer, which includes free guided practices for sleep, stress, anxiety, anger, depression, addiction and exercise. She likes the mood charting apps Wellness Tracker from the Depression and Bipolar Support Alliance and PatientsLikeMe.
CBT Thought Diary is an app that helps you “document your negative emotions, analyze flaws in your thinking, and reevaluate your thoughts.”
SuperBetter “is like a challenge game with ways to earn ‘power ups’ with self-care…[and] has a lot of excellent explanations of how self-care practices positively affect mood states,” King said. For exercise, she uses Map My Fitness.
Remember it’s OK to have setbacks and to make mistakes. “My routines and habits get messed up and re-arranged from time to time,” Howard said. “Don’t let one bad day define your entire future.” Don’t let a few days or months define your entire future.
As Brown said, “always remember, recovery is an ongoing process. Treat yourself lovingly.”