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Why Bipolar Kids Can’t Get Up and Get Going

What Can Be Done About Sleep Inertia?

A good plan of attack would be to discuss the timing of medications with the treating physician. If one or more of the meds is contributing to morning grogginess, than it might help to administer the drug at an earlier time the day before. If anxiety is causing school refusal, the doctor or therapist may ease the fears of the child by helping him or her deal with the anxiety. Cognitive therapy may be particularly helpful.

It is important that parents and teachers recognize that many children with bipolar disorder have co-occurring learning disabilities and executive function deficits, and that these deficits make school embarrassing and dispiriting. Rather than get up and go to school and fail, the youngster may prefer to sleep. Neuropsychological testing will reveal these problems, and the IEP of the student can accommodate these disabilities and make the child or adolescent less anxious.

Phototherapy, or light treatment, may entrain the rhythms and phase shift the dysregulation many of these children have. Some parents have reported that a dawn simulator is helpful in getting their children out of bed.

If the prescribing doctor thinks a trial of melatonin is a good idea, he or she will discuss the timing and dosage. In a pilot study, one of the authors of this newsletter (D.F.P.), found that 3-6 mg of melatonin given approximately 20 minutes before bedtime, not only enhanced the earlier onset of sleep, but in a number of cases abolished sleep-arousal disorders such as night terrors. A more restorative sleep ensued. Since melatonin is known to lower core body temperature, this may explain one of its effects on the regulation of the sleep/wake cycle.

Remember the parents who had to squirt GoGurt in their daughter’s mouth each morning? They told us that they began to give her melatonin each night and she can now get up, get dressed, and eat without the aid of her parents (and Gogurt is no longer the only staple of her morning menu).

Melatonin requires more study, and no one is certain of its long-term effects, nor will it work for everyone. Naturally, much depends on the causes of the sleep inertia.

Until the sleep/wake cycle is regulated (and your child may always be more of an owl than a lark), an accommodation in the school day may have to be made. It might help if the student is allowed a later start, and it would be wise to schedule all academics later in the morning and in the afternoon when he or she would be more cognitively available for learning.

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During the writing of this newsletter, a mother emailed us her philosophy and mantra. She speaks of her “during the school-year child” and her “summer vacation child.” Because her son has learning disabilities, as well as sleep inertia, he feels anxiety, and even has small panic attacks upon arriving at school. She wrote:

Each school morning for me, as a mother, is an adventure. I try not to worry in advance because I never know what each morning will bring me from my son. Is it a good morning for him, or a bad morning? I only find out when HE finds out.

I try not to get anxious or too pushy, but of course sometimes I lose control, especially if there’s a meeting I absolutely can’t miss, or if I have a doctor’s appointment.

I need to be aware of myself, my attitude, my temper, even my breathing. I do my best to slow down, speak reasonably, and gently, and offer whatever alternatives work. I have even been known to offer bribes because I know that once he gets to school, his anxiety usually evaporates and I receive reports later about “what a good day he had.” I need to look at a bad morning as not necessarily a permanent all-day condition.

She concluded by saying:

So my Mom mantra for a school day morning is: (1) Greet each day as a new day. (2) Prepare for different contingencies. (3) Maintain my calm, no matter what. (4) The more agitated my son gets, the calmer, slower, and gentler I get. (5) Take my time: it is more important for him to get to school, than it is important that he get to school on time. (6) Learn to cut my losses, and give up on the day if necessary. (If my son gets too agitated, I have to learn that it’s not the end of the world if he doesn’t get to school that day.)

In my opinion, it’s hard to give consequences for behavior that is brain-induced or slowed down by meds. We just try to impress upon him what we expect from him, what the school expects from him. It can be a moment-to-moment experience.

Why Bipolar Kids Can’t Get Up and Get Going

Demitri Papolos

APA Reference
Papolos, D. (2020). Why Bipolar Kids Can’t Get Up and Get Going. Psych Central. Retrieved on October 23, 2020, from
Scientifically Reviewed
Last updated: 17 Jan 2020 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 17 Jan 2020
Published on Psych All rights reserved.