Living well with bipolar disorder

Bipolar disorder usually needs care for life. But a good treatment plan can calm symptoms and make daily life better.¹ Medicine and therapy are the base of that plan. What you do each day matters too.

This page covers the everyday habits that help most: steady sleep, a mood chart, knowing your own early warning signs, a crisis plan, care with alcohol, and support at work. None of this replaces treatment. It helps your treatment work better.

Why daily habits matter

Bipolar disorder causes episodes of mania or hypomania (a high, wired or irritable mood with too much energy) and episodes of depression. See signs of mania, hypomania and bipolar depression for a full list.

Treatment works best as a team effort. Medicine is the main tool (see medicines for bipolar disorder). U.S. veterans' health guidelines suggest adding a talk therapy, such as family therapy, CBT or a therapy that steadies daily routines, once a manic episode has passed.⁶ Read more on therapy for bipolar disorder.

The National Institute of Mental Health (NIMH) also suggests keeping your visits, keeping a steady routine for meals, sleep and exercise, and leaning on friends and family. Regular exercise, such as walking, swimming or biking, may help mood, sleep and overall health.²

Protect your sleep

Sleep and mood are closely linked in bipolar disorder. A UK study asked more than 3,100 people with bipolar disorder about their episodes. About 1 in 5 (20%) said a period of lost sleep had triggered a high. Fewer, about 1 in 9, said lost sleep had triggered a low.³ Women and people with bipolar I were more likely to report sleep loss setting off a high.³

The study authors pointed to shift work and long flights across time zones as times of special risk.³ Other common sleep breakers include a new baby, a hospital stay, caring for a sick relative, holidays and late nights out.

Losing sleep can also be an early sign of mania itself.⁵ Watch for sleeping much less but not feeling tired. This is different from ordinary trouble sleeping. If it lasts more than a night or two, call your doctor soon.

A therapy called interpersonal and social rhythm therapy (IPSRT) helps people keep steady daily rhythms, such as when they wake, eat and see people.² Ask whether it is available near you.

Keep a mood chart

A mood chart (also called a life chart) is a simple daily record. NIMH suggests one to help you notice mood changes.² Over weeks and months, it shows patterns you might not see from day to day.

What to write down each day:

Bring your chart to each visit. It helps your doctor see how treatment is working and judge any change. Paper works fine. Phone apps are another option. The veterans' health guidelines found too little research to recommend any one app over another.⁶

Our daily check-in can be a gentle place to start noticing how you feel.

Learn your relapse signature

Most people have their own early warning signs before an episode. Doctors sometimes call this pattern a "relapse signature." The signs often look the same each time, so learning them gives you a head start.

NAMI notes that early mania may show up as sleeping less or talking fast, while early depression may start with tiredness or sleep trouble.⁵ Early mania can feel good, so a person may not want to seek help. That is why family and friends can be a big help in spotting signs.⁵

Does it help? A Cochrane review (a careful summary of the best studies) looked at programs that teach people their early warning signs, along with usual care. People in these programs went longer before their next episode and were less likely to be hospitalized. Daily functioning also seemed better at 18 months.⁴ Moderate evidence The review was published in 2007. The programs were often mixed with other therapy, so it is hard to know how much came from the warning-sign part alone.⁴

1. Look back. Think about your last two or three episodes. What changed in the days or weeks before? Look at sleep, spending, talking, social life, appetite and interest in things.
2. Ask someone close to you. Others often notice changes first. Ask, "What did you see before I got sick last time?"
3. Sort the signs into stages. Early signs (for example, needing less sleep or starting many projects), middle signs, and late signs.
4. Write an action for each stage. For example: early sign, call my doctor this week and protect my sleep. Later sign, ask my partner to hold my credit cards and call my doctor today.
5. Share it. Give a copy to your doctor and to one or two people you trust. Agree on what they should do if they notice signs.
6. Review it after each episode. Add anything new you learned.

Make a crisis plan while you are well

A crisis plan is a written plan for what you and others should do if you become very ill. It is easiest to write when you feel well and can think clearly. Our safety plan tool can guide you through the steps.

A good crisis plan includes:

• Your early, middle and late warning signs (your relapse signature)
• Names and phone numbers of your doctor, therapist and pharmacy
• A list of your medicines and allergies
• People you trust to help, and what each one will do
• What helps you calm down, and what makes things worse
• Which hospital or clinic you prefer
• Who will care for children, pets, bills or your job if you cannot
• Money safety steps, such as limits on credit cards during a high

Some people also write a psychiatric advance directive. This is a legal paper that states your treatment wishes in case you cannot decide for yourself during a crisis. Rules differ from state to state. See supporting someone with bipolar disorder and advance directives to learn more.

Alcohol and drugs

Alcohol and bipolar disorder often go together. Studies estimate that 4 to 7 in 10 people with bipolar disorder have an alcohol use disorder (drinking that causes harm but is hard to control) at some point in life.⁷ Drug use is common too.²

Alcohol may seem to calm you down or lift your mood for a while. But it can upset your mood balance and get in the way of your medicines.⁵ When bipolar disorder and alcohol problems occur together, studies link them to:⁷

• Episodes that start earlier and take longer to get better
• More mood swings, mixed episodes (high and low symptoms at the same time) and rapid cycling (four or more episodes a year)
• More suicide attempts
• More trouble staying on medicine

NIMH advises people with bipolar disorder to avoid alcohol and drugs. Some drugs, including some prescription drugs, can copy or worsen mood symptoms.²

Safety tips:

• Tell your doctor how much you drink, even if it is a small amount. This helps them choose safe medicines.
• If you take lithium, tell your doctor if you have a fever, heavy sweating or bad diarrhea. They may need to check your levels or change your plan.⁸
• Ask your pharmacist before taking pain relievers such as ibuprofen or naproxen with lithium. They can interact.⁸
• Never stop or change a medicine on your own. Talk with your doctor or pharmacist first.²

If cutting back is hard, help is available. Ask your doctor about treatment for both conditions at once. See alcohol and older adults for more on drinking in later life.

Bipolar disorder and work

Many people with bipolar disorder work, and work can give structure and purpose. Some people need changes at work to stay well.

Your rights. The U.S. Equal Employment Opportunity Commission (EEOC) says bipolar disorder should easily count as a disability under the Americans with Disabilities Act (ADA).⁹ This means:⁹

• You can usually keep your condition private. An employer can ask medical questions only in certain cases, such as when you ask for an accommodation.
• If you do share health information, your employer must keep it confidential.
• You can ask for a reasonable accommodation, a change that helps you do your job.
• You may also have the right to unpaid leave under the Family and Medical Leave Act (FMLA).

Examples of accommodations from the EEOC and the Job Accommodation Network (JAN):^9,10

• A flexible schedule, or time off for therapy and doctor visits
• Regular rest breaks
• Steady day shifts instead of rotating or night shifts, which can disrupt sleep
• Written instructions and reminders
• A quieter work area
• Working from home some days

JAN gives advice on job accommodations for many conditions. Not everyone with bipolar disorder needs one.¹⁰ If you think you were treated unfairly, the EEOC can help. You usually must file a charge within 180 days, or 300 days in some states. Call 800-669-4000.⁹

Help finding or keeping a job. The veterans' health guidelines suggest a program called Individual Placement and Support (IPS) for people who want help with work. It helps people find regular jobs and gives ongoing support.⁶ In Virginia, the Department for Aging and Rehabilitative Services (DARS) offers job training, job search help and on-the-job coaching for people with disabilities. Call 800-552-5019.¹¹

Later life and changing routines

Big life changes can shake up routines. Retirement, moving, the loss of a spouse or a new health problem can all affect sleep and daily rhythm. Try to build new structure, such as regular wake times, set meals and planned activities. See retirement and mental health.

Bodies also change with age, and some bipolar medicines need closer checks. Read bipolar disorder in later life for more.

When to get help

Call your doctor soon if you notice:

• Your early warning signs, even mild ones
• Sleeping much less without feeling tired, for more than a night or two
• Low mood, loss of interest or hopelessness lasting more than a few days
• Side effects that bother you, or trouble taking your medicine
• Drinking more to cope

For thoughts of suicide, call or text 988. In an emergency, call 911.¹

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.