How to Get Better Sleep With Bipolar Disorder: 8 Quick Tips

It is estimated that around 40–60 million people worldwide live with bipolar disorder, and insomnia is one of the most common symptoms during a manic episode. Just a few consecutive nights of sleep deprivation can worsen symptoms, leading to excessive euphoria, racing thoughts, difficulty controlling behavior, and creating a vicious cycle between bipolar-induced insomnia and manic episodes. This not only affects mental health but also reduces the quality of daily life, work, and relationships.

In this article, Tiptory will guide you through safe, easy-to-apply methods to improve bipolar-induced insomnia, based on mental health recommendations. You will understand why manic episodes make it difficult for the brain to fall asleep, and learn how to build healthy sleep habits to reduce the risk of recurrence, help manage bipolar disorder, and enhance long-term sleep quality.

Part 1: Tips for falling asleep quickly during a manic episode

Tip 1: Accept the current situation

Don't put too much pressure on yourself to fall asleep immediately

• When experiencing a manic episode due to bipolar disorder, difficulty falling asleep is a very common symptom. The more you worry about "having to sleep now," the more the brain maintains an alert state, making bipolar-induced insomnia last longer.
• Instead of constantly checking the clock or forcing yourself to sleep, accept that your body is going through a difficult phase and needs time to stabilize.

Acknowledge your feelings and treat yourself with compassion

• Take a few minutes to breathe slowly and deeply, then remind yourself that what you are experiencing is part of bipolar disorder, not a sign of weakness or failure.
• Accepting your current emotions helps reduce stress, thereby limiting nervous system stimulation—a factor that can worsen manic episodes and insomnia.

Understand that it's not your fault

• Manic episodes occur due to changes in brain activity and are a characteristic manifestation of bipolar disorder, not because of a lack of willpower or doing something wrong.
• Blaming yourself only increases anxiety, while maintaining a calm attitude will support symptom management and effective sleep recovery.

Remind yourself that this phase is temporary

• If you have experienced manic episodes before, remember that symptoms will gradually subside with proper treatment and care.
• Although bipolar-induced insomnia can make you feel very tired, your body will eventually need rest, and you will sleep when the intensity of mania decreases.
• Maintaining faith in the recovery process will help you reduce stress, thereby creating more favorable conditions for sleep to return to normal.

Tip 2: Keep your body relaxed before sleep

Limit movement to help your brain calm down gradually

• When experiencing a manic episode, the body often feels restless, unable to sit still, or constantly wanting to move. Actions like twisting hair, biting nails, shaking legs, or constantly turning over can maintain alertness and prolong bipolar-induced insomnia.
• Once in bed, try to maintain a comfortable position and limit unnecessary movements. This helps reduce stimulation to the nervous system, allowing the body to gradually transition to a state of rest.

Place hands and feet in a fixed position

• Place your hands in a comfortable position, such as on your stomach or along your body, while relaxing your shoulders, neck, and legs.
• Instead of constantly changing positions, focus on the sensation of your body touching the mattress and allow your muscle groups to relax naturally. Keeping your body still can help reduce the urge to move.

Use visualization techniques to reduce restlessness

• If you find it difficult to lie still, try imagining yourself as a statue or a robot standing completely still. This is a simple visualization technique to shift attention away from the restless feeling caused by a manic episode.
• Some people with bipolar disorder find that this method helps them control involuntary movements, reduce nervous stimulation, and fall asleep more easily.

Be patient with your body

• Don't expect yourself to fall asleep immediately. The first goal is to help your body become less active and create a favorable environment for sleep.
• If you lie still for a few minutes combined with slow, even breathing, many people with bipolar-induced insomnia will feel more relaxed and fall asleep more easily as the manic episode gradually subsides.

Tip 3: Calm your mind with a melody

Replace racing thoughts with familiar content

• When a manic episode causes thoughts to race and become difficult to control, direct your attention to a song or poem you love. Focusing on familiar words helps the brain reduce scattered thoughts, thereby aiding in improving bipolar-induced insomnia.
• There's no need to try to remember it perfectly. Just letting your mind gently repeat each line at a natural rhythm is enough to slow down the stream of thoughts.

Prioritize songs or poems with gentle rhythms

• Choose songs with slow, soothing melodies or poems you know by heart. Familiarity helps the brain focus on a single piece of content instead of constantly jumping from one thought to another.
• Avoid fast-paced music, overly energetic lyrics, or content that evokes strong emotions, as these can increase stimulation during a manic episode.

Humming is an option if you're sleeping alone

• If it doesn't disturb others, you can hum or sing softly a gentle melody. The steady sound combined with slow breathing can create a sense of relaxation and help your body prepare for sleep.
• Keep the volume very low and avoid singing for too long. The goal is to calm your mind, not to maintain alertness.

Bring your mind back to a calm state

• If you notice your thoughts starting to speed up again, gently return to the song or poem playing in your head without blaming yourself.
• Repeating this technique multiple times can help individuals with bipolar disorder reduce racing thoughts, help control manic episodes, and improve bipolar-induced insomnia naturally.

Tip 4: Distract yourself with a list

Give your brain a simple task to focus on

• When a manic episode causes thoughts to race, shift your attention to a light mental activity, such as creating a list in your head. This helps keep the brain busy with a structured task, instead of continuing to dwell on thoughts that prolong bipolar-induced insomnia.
• Choose familiar topics that are not stressful and do not require finding exact answers.

Try creating familiar lists

• You can recall the names of streets you've lived on, list your favorite movies, books you've read, or foods you like.
• Also, try imagining a list of places you want to travel, dream careers, or favorite songs. These topics help the mind maintain focus without adding stress.

No need to complete the list

• The goal of this technique is not to remember everything perfectly or organize it flawlessly, but to help the stream of thoughts have a stable and less stimulating direction.
• If you forget or miss an item, continue naturally instead of trying to recall it. This helps maintain a relaxed state before sleep.

Avoid content that easily triggers emotional stimulation

• Do not create lists related to unfinished tasks, financial problems, personal conflicts, or large plans, as these can increase manic episodes and anxiety.
• Prioritize neutral or positive ideas. When the mind is redirected away from obsessive thoughts, people with bipolar disorder often find it easier to relax, which contributes to improving bipolar-induced insomnia.

Tip 5: Listen to relaxing music before sleep

Choose soft music to help your mind slow down

• When a manic episode causes your mind to race, listening to relaxing music can help shift attention and reduce racing thoughts. This is a simple measure to help improve bipolar-induced insomnia before bedtime.
• Lie still in bed and focus on the melody instead of trying to force yourself to sleep immediately.

Prioritize music genres with a slow tempo

• Genres such as classical music, light jazz, instrumental lo-fi, folk music, or meditation music with a steady rhythm are often suitable for relaxation.
• Avoid fast-paced music, loud volumes, or lyrics that evoke strong emotions, as these can increase stimulation during a manic episode.

Keep the volume low

• Play music just loud enough to create a quiet and pleasant atmosphere. Excessively loud volume can cause the brain to remain awake.
• Focus on listening to each melody or instrument instead of letting your mind return to thoughts that prevent you from sleeping.

You can try binaural beats

• Some people with bipolar disorder report feeling more relaxed when listening to binaural beats – tracks that use two different sound frequencies to create the perception of a fluctuating rhythm in the brain.
• However, scientific evidence on the effectiveness of binaural beats for sleep and bipolar-induced insomnia is still limited and not strong enough to confirm benefits. If you want to try it, view it as a relaxation aid, not a replacement for treatment or medical advice.

Tip 6: Breathe deeply to fall asleep easier

Practice deep breathing to relax your body

• When mania causes a racing mind and difficulty sleeping, deep breathing can help the body gradually shift into a relaxed state, contributing to improved insomnia due to bipolar disorder.
• Place one hand on your chest and the other on your abdomen to feel your breath throughout the process.

Inhale slowly through the nose, exhale slowly through the mouth

1. Inhale deeply and slowly through your nose, feeling your chest and then your abdomen slowly expand.
2. Hold your breath for a short time if comfortable; do not force yourself to hold it.
3. Exhale gently through your mouth, feeling your abdomen contract as air leaves your body.
4. Maintain a breathing rate of about 4–6 times per minute and repeat for 10 cycles or more, or until you feel more relaxed.

Combine with your daily bedtime routine

• Perform this exercise after personal hygiene and preparing for bed as usual. This helps create a signal for the brain to recognize that it's time to rest.
• If you don't want to lie down yet, you can also sit in a comfortable position on a chair and practice breathing before getting into bed.

Apply whenever you feel your mind is overstimulated

• Deep breathing is not only useful before sleep but can also be applied at any time of day when bipolar disorder causes feelings of restlessness, anxiety, or racing thoughts.
• This is a discreet technique, easy to perform almost anywhere without any aids. Consistent practice can help reduce stress levels, support the management of manic episodes, and facilitate better improvement in insomnia due to bipolar disorder.

Tip 7: Get out of bed if you're not sleepy

Don't stay in bed too long if you can't sleep

• If you've been in bed for about 15–20 minutes and still can't sleep, gently get out of bed instead of trying to force yourself to fall asleep.
• Lying awake for too long can cause your brain to associate the bed with wakefulness and stress, making insomnia due to bipolar disorder more prolonged, especially during manic episodes.

Choose a relaxing, low-stimulation activity

• Engage in gentle activities such as:
  • Listening to soothing music.
  • Taking a warm bath.
  • Reading a few pages of a book with soft lighting.
  • Practicing breathing exercises or muscle relaxation.
• Avoid bright lights or using phones, computers, and TVs, as strong light and screen content can make your brain more alert.

Don't constantly check the clock

• Constantly checking the time can easily create pressure that you are "losing too much sleep." This feeling of anxiety can intensify manic episodes and make it even harder to sleep.
• If possible, turn the clock away or put your phone out of sight before bed.

Read a book if your mind is too busy

• A book with light content can help redirect attention away from racing thoughts caused by bipolar disorder. When the brain focuses on reading, many people feel more relaxed and sleepy.
• Choose physical books or e-readers that don't emit strong blue light. Avoid overly dramatic, stressful, or emotionally stimulating content.

If you're in a hypomanic phase, know when to stop

• Some people in a hypomanic episode may get engrossed in a book and stay up later than intended.
• If you notice yourself becoming increasingly alert or too focused on reading, put the book down, turn off the light, and return to bed once your body has relaxed. The goal of this activity is to calm the mind, not to maintain prolonged wakefulness.

Tip 8: Use medication as prescribed by your doctor

Use sleeping pills or supportive medication when prescribed by a doctor

• If a psychiatrist has diagnosed bipolar disorder and prescribed medication to aid sleep during necessary periods, use the medication exactly as directed when manic episodes make it difficult to sleep.
• Medication can help improve insomnia due to bipolar disorder, while also contributing to stabilizing circadian rhythms and reducing the risk of manic symptoms becoming more severe.

Do not change dosage without consulting your doctor

• Only take medication at the correct dose, at the correct time, and for the correct duration as prescribed by your doctor.
• Do not arbitrarily increase the dose, take extra medication, or combine multiple sleeping pills just because you don't feel sleepy. Improper use can increase the risk of side effects, drug interactions, or affect the treatment of bipolar disorder.

Discuss with your doctor before taking melatonin

• If you have not been prescribed sleep aids, you can ask your doctor about using melatonin. This is a hormone naturally secreted by the body in the evening to help regulate the sleep-wake cycle.
• Some studies show that melatonin can help improve sleep in some individuals, but its effectiveness in people with bipolar disorder varies between individuals. Therefore, its use should be discussed with a doctor to ensure it is suitable for your health condition and any other medications you are taking.

Do not replace long-term treatment plan

• Sleep aids are only one part of managing insomnia due to bipolar disorder. To effectively manage manic episodes, patients need to adhere to their treatment plan, attend follow-up appointments, and combine this with measures such as maintaining a regular sleep schedule, limiting stimulants, and practicing relaxation techniques before bed.

Part 2: How to establish a sleep routine for people with bipolar disorder

Tip 1: Maintain a consistent nightly sleep routine

Establish a pre-bedtime schedule

• Maintaining a consistent routine every evening is one of the important measures to improve insomnia due to bipolar disorder and reduce the risk of manic episodes appearing or recurring.
• When pre-sleep activities are repeated regularly, the brain will gradually form signals that it's time to rest, helping you fall asleep more easily.

Engage in relaxing activities before bedtime

• You can create an evening routine that includes gentle activities such as:
  • Performing a few stretching exercises.
  • Tidying up your sleeping space.
  • Preparing clothes or items for the next day.
  • Taking a warm bath.
  • Reading a book with light content.
• Maintain these steps in the same order every day to form a stable habit.

Limit bright light and electronic devices

• Light from phones, computers, TVs, and other electronic devices can reduce melatonin secretion, making it difficult for the brain to recognize that it's time to sleep.
• It is recommended to limit the use of devices with bright screens or engaging in mentally stimulating activities before bed. Instead, prioritize dim lighting and a quiet environment to help improve insomnia due to bipolar disorder.

Go to bed at the same time every day

• Try to go to bed and wake up at the same time, even on weekends or days off. Maintaining a stable sleep schedule helps the biological clock function more effectively and supports the management of bipolar disorder.
• Additionally, all electronic devices should be turned off at least 1 hour before bed to reduce brain stimulation and create favorable conditions for the body to relax.

Persistently maintain the habit long-term

• The effectiveness of sleep hygiene often does not appear immediately after one or two days but needs to be maintained regularly for several weeks.
• Combining a stable sleep schedule with treatment as directed by a doctor can help individuals with bipolar disorder improve sleep quality, reduce insomnia due to bipolar disorder, and contribute to limiting the risk of recurrent manic episodes.

Tip 2: Use the bedroom only for rest

Turn the bedroom into a space solely for sleep

• To improve insomnia due to bipolar disorder, create a clear association between the bedroom and rest. When the brain only remembers that this is a place for sleep, you will relax and fall asleep more easily.
• If you frequently work, study, or entertain yourself in bed, your brain may remain in an alert state instead of preparing for sleep.

Do not work or entertain yourself in bed

• Avoid bringing laptops into bed for work or study.
• Avoid watching TV, browsing social media, playing games, or watching videos directly in bed before sleep.
• These activities can increase brain stimulation, making manic episodes harder to control and prolonging insomnia due to bipolar disorder.

Move other activities to a separate space

• If you need to work, read documents, or use electronic devices, do so in a study, living room, or another area outside the bedroom.
• When you finish working, return to the bedroom to rest. This habit helps the brain clearly distinguish between work time and sleep time.

Create a quiet and comfortable sleep environment

• Keep your bedroom clean, tidy, quiet, and at a comfortable temperature to support sleep quality.
• A space with little noise, soft lighting, and few distractions will help individuals with bipolar disorder relax better, contributing to reduced insomnia due to bipolar disorder and supporting long-term management of manic episodes.

Tip 3: Create a sleep-friendly bedroom

Keep the bedroom dark, cool, and quiet

• A suitable sleeping environment can help individuals with bipolar disorder relax more easily, thereby supporting the improvement of bipolar insomnia.
• Keep the bedroom cool, minimize light, and reduce noise as much as possible to help the body transition into a resting state.

Invest in appropriate blankets, sheets, pillows, and mattresses

• Choose a mattress, pillows, and blankets that provide comfort, good body support, and suit your sleeping habits.
• A comfortable sleeping space helps reduce discomfort when lying down for long periods, especially during manic episodes that make it difficult to fall asleep.

Limit light entering the room

• Use blackout curtains to reduce light from streetlights or early morning sun.
• If you cannot completely darken the room, you can wear an eye mask to limit light exposure that affects your biological clock and supports natural melatonin production.

Reduce noise when necessary

• If you live with family, roommates, or in a noisy area, consider using earplugs to create a quieter environment.
• Additionally, you can use white noise or natural sounds at a low volume to mask sudden noises, helping to maintain more stable sleep.

Adjust the temperature to a comfortable level

• Most adults sleep better in a slightly cool environment. Adjust the air conditioner or fan to a temperature that makes you feel comfortable, avoiding a room that is too hot or too cold.
• When combining a suitable sleeping environment with a regular daily routine and proper treatment, individuals with bipolar disorder can improve sleep quality, reduce bipolar insomnia, and effectively manage manic episodes.

Tip 4: Limit alcohol and caffeine in the evening

Reduce alcohol and caffeinated beverages before bedtime

• If you have bipolar disorder, especially during manic episodes, you should limit alcohol, beer, coffee, strong tea, energy drinks, or other caffeinated beverages in the afternoon and evening.
• If your doctor has advised avoiding these beverages entirely due to ongoing medication, adhere strictly to their instructions to minimize the risk of affecting sleep and health.

Don't think alcohol helps you sleep well

• Although a few alcoholic drinks might make you fall asleep faster, alcohol often reduces sleep quality, leading to restless sleep and frequent awakenings during the night.
• Many studies also show that alcohol can be a trigger or worsen manic episodes in some individuals with bipolar disorder. Therefore, avoiding alcohol before bedtime is a safer choice.

Stop caffeine intake from the afternoon

• Caffeine is a central nervous system stimulant and can remain in the body for many hours after consumption.
• To improve bipolar insomnia, limit coffee, strong tea, energy drinks, or caffeinated sodas from early to mid-afternoon, especially if you often have trouble sleeping at night.

Replace with relaxation-promoting beverages

• In the evening, you can choose plain water, warm milk, or caffeine-free herbal teas, provided there are no contraindications from your doctor.
• Combining limited alcohol and caffeine with a regular sleep schedule, a suitable sleeping environment, and the correct treatment regimen will help individuals with bipolar disorder improve bipolar insomnia and contribute to more effective management of manic episodes.

Tip 5: Limit long naps

Avoid excessive napping to protect nighttime sleep

• Short naps sometimes don't cause problems, but if you frequently nap for too long, your biological clock can get disrupted, making it difficult to fall asleep at night.
• For individuals with bipolar disorder, maintaining a stable sleep schedule is a crucial factor in improving bipolar insomnia and supporting the management of manic episodes.

Long naps can create a vicious cycle

• When you sleep too much during the day, your body's need for sleep at night decreases.
• This leads to staying up later, sleeping less at night, and feeling sleepy again the next day.
• If this situation repeats continuously, the sleep-wake cycle will become increasingly disrupted, making bipolar insomnia harder to improve.

If a nap is needed, limit its duration

• If you are too tired, prioritize a short nap of about 20–30 minutes and avoid napping in the late afternoon or early evening.
• If your treating physician provides different instructions based on your bipolar disorder, prioritize following those instructions.

Prioritize daytime alertness

• Exposure to natural light in the morning, light exercise, and maintaining daily activities can help the body stay more alert without needing compensatory sleep.
• Limiting long naps combined with fixed bedtime and wake-up times each day will contribute to improving bipolar insomnia, stabilizing circadian rhythm, and reducing the risk of triggering or worsening manic episodes.

Tip 6: Take a warm bath before bed

Take a warm bath to help your body relax

• If a manic episode makes it difficult for you to calm down or if bipolar insomnia is persistent, taking a warm bath before bedtime can help your body relax and feel more comfortable.
• The warm temperature of the water helps muscles relax, reduces tension, and signals the body to prepare for rest.

Make bathing part of your evening routine

• Spend about 10–20 minutes soaking in a warm bath or taking a warm shower.
• You can combine soft lighting and gentle music to create a relaxing atmosphere, but avoid loud sounds or excessively bright lights as they can increase stimulation before sleep.

Reduce repetitive thoughts

• During a manic episode, many people often get caught in continuous thought streams or find it hard to stop focusing on an issue.
• The warm sensation of water combined with a quiet space can help shift attention to bodily sensations, thereby reducing rapid thoughts and supporting the improvement of bipolar insomnia.

A warm shower also provides similar benefits

• If you don't have a bathtub or don't like soaking, a warm shower before bedtime can also provide similar relaxing effects.
• Combining warm baths with a regular sleep schedule, a quiet sleeping environment, and your doctor's treatment plan will help individuals with bipolar disorder improve sleep quality and support more effective management of manic episodes.

Tip 7: Meditate before bedtime

Spend a few minutes meditating each day to calm your mind

• Meditation is a method proven by many studies to help reduce stress, improve concentration, and support sleep quality.
• For individuals with bipolar disorder, maintaining regular meditation can help reduce thought disarray, thereby supporting the improvement of bipolar insomnia and emotional stability. However, meditation should be considered a supportive measure, not a replacement for medical treatment.

Perform a simple meditation before bed

1. Choose a quiet place, with minimal distractions.
2. Sit comfortably in a chair or on the floor, keeping your back straight but not stiff.
3. Gently close your eyes and relax your entire body.
4. Breathe naturally, focusing on the sensation of air entering and leaving with each breath.
5. When you notice your mind getting caught up in thoughts due to a manic episode, gently bring your attention back to your breath without judging yourself.

Start with a short duration

• You don't need to meditate for too long right from the start. Just 5–10 minutes a day is enough to form a habit, then you can gradually increase the duration as you feel comfortable.
• The important thing is consistency rather than trying to meditate for long periods infrequently.

Benefits of consistent meditation

• Research shows that even about 13 minutes of meditation per day can help improve attention, memory, and mood in many healthy individuals.
• When combined with sleep hygiene, doctor-guided treatment, and a healthy lifestyle, meditation can contribute to reducing bipolar insomnia, supporting the management of manic episodes, and improving quality of life.

Guided meditation can be used

• If you are new to meditation or find it hard to focus, you can choose guided meditations with audio or voice-overs for short durations.
• Prioritize content with a slow pace, gentle narration, and avoid programs with overly stimulating sounds before bedtime.

Tip 8: Muscle relaxation before bed

Apply progressive muscle relaxation techniques

• Progressive Muscle Relaxation (PMR) is a technique that helps reduce muscle tension and calm the nervous system. This method is often used to support the improvement of bipolar insomnia, especially when manic episodes keep the body in a state of restlessness and difficulty relaxing.
• You should perform it before getting into bed or in a quiet space to allow your body time to transition into a resting state.

Follow these simple steps

1. Sit or lie in a comfortable position.
2. Breathe slowly and deeply a few times to relax your body.
3. Starting from your feet, clench your muscles tightly for about 5–10 seconds if it feels comfortable.
4. Completely relax for 10–20 seconds, noticing the difference between tension and relaxation.
5. Continue with muscle groups such as calves, thighs, glutes, abdomen, back, shoulders, arms, hands, neck, and facial muscles until the entire body is complete.

Do not clench muscles too tightly

• The goal of the exercise is to help the body recognize the feeling of relaxation after releasing tension, not to put pressure on the muscles.
• If you have an injury, muscle pain, or musculoskeletal condition, skip that area or consult your doctor before performing.

Maintain regularly for increased effectiveness

• Many studies show that about 20 minutes of progressive muscle relaxation can help improve feelings of calm, reduce stress, and boost mood in many people.
• When combined with deep breathing, meditation, sleep hygiene, and doctor-prescribed treatment, this technique can help reduce insomnia due to bipolar disorder, assist in controlling manic episodes, and help you fall asleep more easily.

Tip 9: Exercise regularly every week

Stay active to stabilize mood

• Regular exercise is one of the beneficial habits for people with bipolar disorder. Physical activity helps reduce stress, improve mood, and contribute to regulating circadian rhythms, thereby helping to reduce insomnia due to bipolar disorder.
• Maintaining regular physical activity can also help control restlessness and reduce the impact of manic episodes when combined with doctor-prescribed treatment.

Prioritize morning or early day workouts

• Exercise should be done in the morning or at least 3–4 hours before bedtime.
• Avoid high-intensity exercise in the evening as it can increase heart rate, body temperature, and alertness, making it harder to fall asleep.

Aim for at least 150 minutes per week

• Adults should maintain about 150 minutes of moderate-intensity physical activity per week, adding muscle-strengthening exercises two or more days if suitable for their health condition.
• Start at a level that suits your fitness and gradually increase workout duration for long-term maintenance.

Choose suitable forms of exercise

• You can choose activities such as:
  • Brisk walking.
  • Yoga or Pilates.
  • Cycling.
  • Swimming.
  • Jogging.
  • High-intensity workouts if you have a fitness foundation and your doctor approves.
• The important thing is to choose an activity you enjoy to make it easier to maintain as a habit.

Persevere with exercise for long-term benefits

• In addition to helping improve insomnia due to bipolar disorder, regular exercise also helps strengthen cardiovascular health, control weight, reduce the risk of many chronic diseases, and improve quality of life.
• For people with bipolar disorder, maintaining physical activity combined with regular sleep, a healthy diet, and adherence to the correct treatment regimen can help stabilize mood, reduce the risk of recurrence of manic episodes, and depressive phases.

Tip 10: Use visualization for easier sleep

Practice guided imagery techniques

• Guided imagery is a relaxation technique that helps reduce stress and distract the mind from the racing thoughts caused by manic episodes.
• This method encourages you to focus on peaceful images to help your body and brain gradually enter a state of rest, thereby helping to improve insomnia due to bipolar disorder.

Imagine a relaxing scene

• Close your eyes and imagine yourself walking in a green field, sitting by the beach, listening to the waves, or strolling through a quiet forest.
• Try to feel as many details as possible, such as sounds, smells, light, the breeze, or the surrounding temperature. Engaging multiple senses will help you focus better and reduce racing thoughts.

Combine with slow breathing

• While visualizing, breathe steadily and slowly, maintaining your focus on the imagined scene.
• If your mind returns to thoughts that keep you awake, gently bring your focus back to the relaxing image without self-reproach.

Consider using audio guides

• If you're new to this, you can listen to guided visualization or relaxation exercises before bed. A gentle voice combined with a slow guided rhythm can make it easier to perform.
• Choose content without ads, adjust the volume to a moderate level, and turn off the screen after starting playback to minimize the impact of blue light on sleep.

Maintain as part of your pre-sleep routine

• Practicing guided imagery every evening combined with sleep hygiene, a consistent sleep schedule, and doctor-prescribed treatment can help people with bipolar disorder reduce stress, improve insomnia due to bipolar disorder, and help control manic episodes more effectively.

Tip 11: Avoid triggers

Recognize factors that easily trigger manic episodes

• Each person with bipolar disorder may have different triggers. Early recognition of these factors helps you proactively prevent manic episodes and reduce the risk of insomnia due to bipolar disorder.
• Monitor your emotions, sleep, and daily events to identify situations that often exacerbate symptoms.

Limit exposure to stressors

• Common factors that can increase the risk of triggering manic episodes include:
  • Prolonged stress.
  • Conflicts or arguments with others.
  • Work or study pressure.
  • Lack of sleep for several consecutive days.
• When possible, reduce your exposure to these stressors or prepare measures to help yourself relax and recover.

Address stressful tasks early

• If you need to solve a difficult problem or attend an important meeting, prioritize doing it in the morning or early afternoon.
• Completing stressful tasks early will give you more time to relax before bed, thereby helping to improve insomnia due to bipolar disorder.

Prepare for unavoidable factors

• Some factors, such as changes in weather, seasons, time zones, or major life events, can be difficult to control completely.
• During these periods, try to maintain a stable sleep schedule, avoid over-scheduling tasks, and dedicate more time to rest to reduce the risk of manic episodes recurring.

Develop a long-term prevention plan

• Preparing in advance for stressful situations is an important part of managing bipolar disorder.
• Combining trigger identification with doctor-prescribed treatment, maintaining a healthy lifestyle, and good sleep hygiene will help reduce insomnia due to bipolar disorder, stabilize mood, and improve long-term quality of life.

Part 3: When to seek help for bipolar disorder?

Note 1: Treatment with a psychiatrist

Choose a psychiatrist experienced in treating bipolar disorder

• If you are diagnosed with bipolar disorder, you should be monitored by a psychiatrist experienced in treating this condition.
• The doctor will assess symptoms, the severity of manic episodes, the state of insomnia due to bipolar disorder, and other health factors to develop an appropriate treatment plan for each individual.

Take medication as prescribed

• Take medication at the correct dose and time, and do not stop taking it without consulting your doctor, even if symptoms have improved.
• Missing doses or suddenly stopping medication can increase the risk of recurrent manic episodes, sleep disturbances, and depressive episodes.
• If you forget to take your medication or encounter difficulties during treatment, discuss it with your doctor for guidance instead of self-adjusting.

Report sleep problems early

• Do not underestimate insomnia due to bipolar disorder. Prolonged sleep deprivation can worsen the symptoms of the illness and increase the risk of manic episodes appearing.
• If you frequently have difficulty falling asleep, wake up multiple times, or feel that your sleep is not restorative, inform your doctor as soon as possible for assessment and adjustment of your treatment plan if needed.

Discuss if medication affects sleep

• Some medications for bipolar disorder can affect sleep in some individuals, while others help improve sleep quality. Effectiveness and side effects can vary depending on the individual.
• If you suspect that your current medication is causing difficulty sleeping, excessive drowsiness, or discomfort, discuss it with your doctor. The doctor may consider adjusting the dose, changing the type of medication, or adding appropriate treatment methods.
• Do not stop or change medication without your doctor's guidance, as this can lead to uncontrolled illness.

Combine treatment and a healthy lifestyle

• Effective management of bipolar disorder not only relies on medication but also requires maintaining a regular sleep schedule, appropriate exercise, limiting alcohol and stimulants, and learning to manage stress.
• The combination of medical treatment and healthy lifestyle habits will help reduce insomnia due to bipolar disorder, limit the recurrence of manic episodes, and improve long-term quality of life.

Note 2: Consider sleep aids

Discuss with your doctor if insomnia persists

• If insomnia due to bipolar disorder occurs frequently or recurs many times, discuss it with your psychiatrist to assess the cause and choose an appropriate treatment method.
• Controlling sleep is an important part of treating bipolar disorder, as prolonged sleep deprivation can increase the risk of manic episodes appearing or worsening.

Sleep aids need to be individualized

• Depending on symptoms and health condition, the doctor may consider using some medications for bipolar disorder that have sleep-aiding effects or prescribe additional sleeping pills in necessary cases.
• Each type of medication has a different mechanism of action, benefits, and risks of side effects. Therefore, no single medication is suitable for everyone.

Some medications may be prescribed by your doctor

• In clinical practice, doctors may consider medications such as quetiapine, trazodone, or other medications if suitable for the condition.
• For some cases of insomnia due to bipolar disorder for a short period, the doctor may also prescribe tranquilizers such as benzodiazepine. However, these medications should generally only be used for a short time due to the risk of dependence and many unwanted side effects if used long-term.

Do not self-medicate or use sleeping pills without medical supervision

• You should not self-medicate with sleeping pills, tranquilizers, or over-the-counter antihistamines just because you have difficulty sleeping. Some medications can interact with bipolar disorder medications, increasing side effects or being unsuitable for your health condition.
• If you need to use any sleep aid, consult your doctor or pharmacist before use.

Assess benefits and risks before treatment

• When your doctor suggests a sleep aid, discuss the expected efficacy, potential side effects, duration of use, and monitoring plan during treatment.
• Medication treatment will be more effective when combined with sleep hygiene, maintaining a regular sleep schedule, stress management, and adherence to the bipolar disorder treatment regimen. This comprehensive approach helps improve insomnia due to bipolar disorder, while also helping to limit the recurrence of manic episodes and improve quality of life.

Note 3: Try IPSRT therapy

Consider IPSRT therapy to stabilize life rhythms

• If you frequently experience insomnia due to bipolar disorder or recurrent manic episodes, discuss Interpersonal and Social Rhythm Therapy (IPSRT) with your doctor.
• This is a psychotherapy developed specifically for people with bipolar disorder, with the goal of helping to maintain a stable daily schedule, improve sleep, and reduce the risk of recurrence of manic or depressive episodes.

Stabilize your biological clock daily

• IPSRT is based on the principle that erratic changes in sleep times, wake times, meals, or daily activities can disrupt circadian rhythms and affect mood.
• During treatment, the therapist will help you establish a regular routine, including:
  • Going to bed and waking up at the same time.
  • Eating meals at fixed times.
  • Maintaining a reasonable schedule for work, study, and rest.
  • Developing habits that help improve insomnia due to bipolar disorder.

Learn to manage relationships and stress

• IPSRT not only focuses on sleep but also helps you identify life factors that can affect your mood, such as family conflicts, work pressure, or major life changes.
• Improving communication skills and stress management can help limit the risk of manic episodes and maintain a more stable emotional state.

Support in controlling energy levels

• People with bipolar disorder may experience periods of abnormally high energy or, conversely, excessive sleepiness and lack of energy.
• IPSRT helps you monitor these changes, thereby adjusting your routine and coordinating with your doctor to address symptoms promptly before they become severe.

Find an experienced therapist

• IPSRT can be conducted individually or in groups under the guidance of a mental health professional.
• When choosing a therapist, prioritize someone with experience in treating bipolar disorder or who has been trained in IPSRT. Combining this therapy with medication, sleep hygiene, and a healthy lifestyle can help reduce insomnia due to bipolar disorder, stabilize mood, and limit the long-term recurrence of manic episodes.

Long-term health monitoring

Seek immediate help if you have self-harming thoughts

• If you have thoughts of self-harm or feel unsafe, seek immediate support from family, your treating doctor, emergency services, or a crisis hotline in your area.
• This is an urgent situation that requires intervention. Early support can help ensure safety and reduce the risk of bipolar disorder symptoms becoming more severe.

Maintain a consistent daily sleep routine

• A stable sleep schedule is a crucial foundation for managing insomnia due to bipolar disorder and reducing the risk of recurrent manic episodes.
• Try to go to bed and wake up at the same time every day, including weekends. Avoid staying up late for extended periods or oversleeping, as both can disrupt your circadian rhythm and affect your mood.

Avoid self-adjusting medications or supplements

• Before using any over-the-counter medications, supplements, herbs, or implementing a new healthcare method, discuss it with your treating doctor.
• Some products can interact with bipolar disorder medications, affecting treatment efficacy or causing unwanted side effects.

Consult your doctor about any unusual changes

• If you notice persistent insomnia due to bipolar disorder, rapid mood changes, abnormally increased energy levels, or signs of a manic episode, contact your doctor early instead of waiting for your next scheduled appointment.
• Regular monitoring and timely adjustment of the treatment plan can help effectively control symptoms, reduce the risk of recurrence, and improve quality of life.

References

1. American Academy of Sleep Medicine. (2023). International Classification of Sleep Disorders (3rd ed., Text Revision). Darien, IL: American Academy of Sleep Medicine.
2. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., Text Revision; DSM-5-TR). Arlington, VA: American Psychiatric Association Publishing.
3. Boland, E. M., Goldschmied, J. R., & Kelly, M. R. (2020). Advances in the management of sleep disturbance in bipolar disorder. Current Psychiatry Reports, 22(7), 1–11.
4. Frank, E. (2005). Treating Bipolar Disorder: A Clinician's Guide to Interpersonal and Social Rhythm Therapy. New York, NY: Guilford Press.
5. Frank, E., Swartz, H. A., & Kupfer, D. J. (2000). Interpersonal and social rhythm therapy: Managing the chaos of bipolar disorder. Biological Psychiatry, 48(6), 593–604.
6. Harvey, A. G. (2008). Sleep and circadian rhythms in bipolar disorder: Seeking synchrony, harmony, and regulation. American Journal of Psychiatry, 165(7), 820–829.
7. Harvey, A. G., Soehner, A., Kaplan, K. A., Hein, K., Lee, J., Kanady, J., Li, D., Rabe-Hesketh, S., & Buysse, D. J. (2015). Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: A pilot randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(3), 564–577.
8. National Institute for Health and Care Excellence. (2023). Bipolar Disorder: Assessment and Management (Clinical Guideline CG185). London: National Institute for Health and Care Excellence.
9. National Institute of Mental Health. (2024). Bipolar Disorder. Bethesda, MD: National Institute of Mental Health.
10. Riemann, D., Baglioni, C., Bassetti, C., et al. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675–700.
11. Swartz, H. A., & Frank, E. (2001). Psychotherapy for bipolar depression: A phase-specific treatment strategy? Bipolar Disorders, 3(1), 11–22.
12. World Health Organization. (2022). International Classification of Diseases 11th Revision (ICD-11): Mental, Behavioural or Neurodevelopmental Disorders. Geneva: World Health Organization.

Content editor: Ashley Wright Nguyen.

Information consulted and verified by expert: Amelia Wilson.