Tracking My Sleep as If My Life Depends on It

Lack of sleep has triggered hospitalizations, so I monitor my sleep like nobody’s business! Without enough rest, I feel worn out, lose my ability to reason, and struggle with impulsivity.

Sleep Deprivation & Hospitalization with Bipolar

I just can’t compete in the “sleep-stakes.”

“I get all the Girl Scouts paperwork done after midnight. It’s so quiet then.”

“Don’t stress out about dinner. Just use a Crock-Pot. If you get up at 4 in the morning, you can chop and prep before getting ready for work.”

The working mothers I know seem to compete for bragging rights to sleep deprivation. Sometimes I feel as if needing eight hours of shut-eye a night brands me as a loser mom. But if I start chopping and prepping in the wee hours, I might as well prep my suitcase for the hospital.

I track my sleep balance as if my life depends on it—well, my life as a healthy, functioning, mania-free adult, anyhow. I don’t need any more “vacations” in psych wards because I convinced myself it was a tremendous advantage to exist on less and less sleep, losing my ability to reason, control my impulses, and exercise good judgment along the way.

Nighttime & Daytime Routines for Sleep

The art of sleeping soundly has become a critical component in my long-term stability with bipolar disorder. My nighttime rituals include soft light, soft pajamas, a soft pillow, and, if necessary, the sound of soft rain via CD. My daytime ritual of exercising regularly provides insurance that I will sleep soundly.

I generally sleep a tad more than seven hours on weeknights, slightly longer on weekends. Juggling a challenging job, a tricky commute, freelance assignments, my spiritual practice, and helping with homework and youth sports and activities can whittle that down to six hours.

After one night of abbreviated sleep, meeting my deadlines at work takes effort, my head throbs faintly, and I crave caffeine. After two nights, I struggle to get out of bed, feel as if I’m recovering from the flu, and start tearing up to Pink Floyd.

To ease the pain and prevent hypomania, I sometimes resort to daytime dozing.

At lunchtime I stroll nonchalantly out to my car, move the front seat back as far as it will go, extract the kitchen timer from underneath it, and set the alarm for 45 minutes. (I’m told that napping more than an hour can make it harder to sleep at night, which would defeat the purpose here.)

Then I grab the throw blanket I snatched from our couch when I left the house at 6 a.m. If the guard spots me while making his rounds, the blanket will let him know I am napping and not a victim of deadly lunch-special sushi. As my eyes get heavy, I consider marketing “Driver Napping” car window signs.

I even squeeze in a nap from time to time at one of my son’s baseball tournaments. This involves screwing up my courage to ask another mom to keep an eye on my adventurous 8-year-old daughter, thereby revealing that I am OK missing 30 minutes of our future MLBers in action. My need to catch up on sleep is greater than my shame.

When I start to resort to such ploys, though, I know it’s time to rearrange my schedule to allow for more nighttime sleep. In my life, rested and relaxed is the ultimate OK. Too bad I can only brag to me, myself, and my two closest friends about how many years it’s been since lack of sleep triggered a trip to the hospital.

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Tips for Successful Sleep

The importance of protecting your sleep can’t be overemphasized. Ellen Frank, PhD, lays it out this way: “If grandma needs to go to the ER in the middle of the night, someone else should do it.”

Frank directs the Depression and Manic Depression Prevention Program at the University of Pittsburgh Medical Center’s Western Psychiatric Institute. She advocates establishing firm daily “rhythms” in activities such as sleeping, waking, eating, and exercising to manage bipolar.

Improving your sleep might be as simple as tweaking your daily activities. Some things to look at:

When Do You Exercise?

In 2012, Brazilian researchers analyzed 18 years’ worth of studies evaluating exercise and sleep quality and concluded, “Exercise is effective to decrease sleep complaints and treat chronic insomnia.”

“Exercise is one of the best things you can do for sleep, mood, and anxiety,” agrees sleep disorders specialist Atul Khullar, MD, MSc, FRCPC (Psychiatry)—but not late in the day, because you don’t want to stimulate your body systems too close to bedtime.

“The key point is to make sure you finish exercising three to four hours before bedtime,” says Khullar, who is medical director of the Northern Alberta Sleep Clinic and a clinical assistant professor at the University of Alberta.

When Do You Leave the House?

Exposure to daylight in the early morning helps set the body’s time clock so you’ll be ready to sleep in the evening. If you can’t get outside in the morning, Khullar says, phototherapy (also known as light therapy) can be a helpful substitute. He cautions that the light exposure occasionally can trigger hypomania.

When Do You Take Your Meds?

Because many mood stabilizers have a sedative effect, taking them in the evening may help promote sleep, Khullar says. Consult your prescribing physician to see if that’s worth trying.

When Do You Consume Caffeine?

Sleep experts generally recommend no caffeine after mid-afternoon—if at all. Studies have shown that caffeine can affect both your ability to fall asleep and your sleep quality (by limiting the deep, restorative stage of the sleep cycle).

“Reducing or eliminating caffeine can be really helpful,” says Frank, but notes: “It is important to withdraw gradually…. If you go cold turkey, you will not feel good.”

Frank also urges vigilance about caffeine in products besides coffee, including tea, soda, energy drinks, energy bars, and chocolate.

When Do You Log Off?

Try not to look at a computer or handheld screen within a half-hour of bedtime. Frank explains that light hitting the retina at close range suppresses the natural melatonin cycle that gets us ready to sleep a few hours after daylight fades. If you’re especially sensitive, she says, the screen blackout might need to be three or four hours.

When Do You Head to Bed?

Having a regular bedtime, even on weekends, helps train your mind and body that it is time to sleep. You’ll also benefit from a bedtime routine that helps you wind down. For example, taking a warm, lavender-scented bath in dim light is soothing—and triggers a drop in body temperature about 90 minutes later that signals the body to sleep.

When Do You Give Up?

You can try all kinds of things to fall asleep: deep breathing, visualizing yourself doing something mindless like walking downstairs, or putting on white noise or calming nature sounds. Khullar recommends cognitive behavioral exercises to counteract wakefulness, such as the ones in The Insomnia Workbook, by Stephanie Silberman. Learning to leave worries at the bedroom door may not completely cure insomnia, he says, but even a 20 to 30 percent gain in time sleeping brings benefits.

If nothing works, Frank recommends surrendering after 20 minutes or so. “You want your bed to be a stimulus for going to sleep. Lying awake breaks that behavioral link between bed and sleep,” she says. So get up, but keep the lights low and find a relatively boring activity—nothing too mentally engaging or physically active (as in, don’t clean the kitchen.)

Printed as “Sleep Smarts,” Winter 2013