The more tired you are, the easier it is to fall asleep at night. To make sure you’re sleepy at bedtime, it’s important to try your best to both avoid daytime napping and to minimize stimulant use. Caffeine in coffee, tea, energy drinks and sodas, nicotine, or energizing drugs will decrease your sleep drive if used after midday. After a poor night’s sleep, it’s tempting to use naps and stimulants (like coffee) to get through the day. This is a perfectly understandable strategy, but it can become a vicious cycle if continued for more than a day or two. It’s also important to know that while alcohol can help people fall asleep, it disturbs sleep during the night. Also, there are more effective ways to relax in the evening than by having a few drinks, as we’ll discuss later.

Successful psychological treatments for depression encourage plenty of daytime activity (some of these types of treatments are called behavioural activation and activity scheduling), which has positive effects on sleep as well as mood and motivation¹⁴. Increased daytime activity is a good sleep strategy for people with bipolar disorder, but one important warning must be added – because of the risk of mania, be mindful of over-stimulation. Monitoring activity and mood levels is important in bipolar disorder generally, and needs to be used when dealing with sleep problems¹⁵.

Some people with significant sleep problems may be prescribed a short course of hypnotic medications to help increase their sleep drive. If you are taking hypnotic medications for sleep problems, it is particularly important to keep reviewing their use with a clinician, as studies suggest that long-term use of these medications may have harmful effects¹⁶ or be inappropriate for people with other substance use concerns¹⁷.

You can train your internal clock to better align with appropriate sleep and wake times by keeping a regular routine. One of the most powerful strategies for improving your sleep is to have a regular wake-up time every day – this includes weekends! The brain’s internal clock needs to be set every day, and it gets the information on how to set itself from our activity and exposure to light. With a reliable wake-up time throughout the week, your internal clock can create a steady 24-hour pulse and can work better when it tries to set you to sleep again about 16 hours after waking up¹⁸.

For many people, a wake up time of around 7:30 AM is a good goal; however, lifestyle and other factors might make a wake time of 8:30 AM or even 9:00 AM more appropriate for some people with bipolar disorder. It’s important to get out of bed as soon as you wake up, even if you feel that you haven’t had enough sleep. Many people find that gentle exercise (especially outdoors) upon waking up improves mood; it’s also very good for your internal clock.

The internal clock also benefits from regular timing of other daily activities. The most important ones to keep in mind are socializing, eating and exercising. It may be surprising to hear that sleep at night depends strongly on the regularity of a person’s daytime activities. Some lifestyles help you keep regular daily activities (e.g., a 9-to-5 job), others challenge regularity (e.g., night shifts, on-call jobs). As well, some life events can be predicted to disturb regularity (e.g., a new baby or a holiday): you can plan for these events and be aware that they will impact your daily routines so that you will be better able to make changes and even possibly keep some of your routines intact¹⁹.

There are three main things you can do to decrease arousal and increase relaxation at bedtime: develop a pre-sleep routine, don’t let stress or excitement follow you to bed and associate your bed and bedroom with sleep.

First, develop a relaxing pre-sleep routine. In the 2 or 3 hours before bed, avoid stimulation. Emotional stimulation arises from intense discussions with partners and housemates, stimulating television, music or Internet surfing. Stimulation from light can really disturb sleep at night, and is an easy thing to stay away from before bed. To do this, keep room lighting to a minimum and avoid the light from screens – especially close-up screens like laptops, smartphones and tablets. Physical stimulation comes from exercise close to bedtime.

If you have a cat, you may have noticed that cats prepare for sleep by calmly circling around and clawing the couch – we humans also benefit from rituals around bedtime. Develop a routine around sleep so that your body learns that bedtime is coming. Some people have a habit of an evening drink (milk or chamomile tea may aid sleep), others have routines around their pets or closing up the house for the night.

Second, manage stress and excitement that can interfere with sleep. It’s just not usually possible to solve big problems after dark. When we’re tired and under-resourced, molehills inevitably turn into mountains. To improve sleep, it’s important to address concerns and anxieties before the sun sets. Practicing meditation or progressive muscle relaxation before bedtime can help you to relieve residual stress from the day. If any concerns do arise around bedtime, a strategy to effectively get them off your chest is to write them down to take care of the next day.

For people with bipolar disorder, excitement and stimulation are very important to manage in the evening. It can be tempting to pursue new ideas and projects into the night, but it’s useful to remind yourself that these things can wait: if it’s really a good idea, it will still be a good idea in the morning.

If you have worries about sleep itself, these should be actively addressed with your healthcare professional. Some people have distressing associations with sleep and bed – careful discussion with your healthcare professional can help you to form more beneficial and realistic thoughts about sleep.

Third, try to associate your bed with rest and relaxation, rather than productivity. Spending hours in bed tossing and turning, binge-watching the latest true-crime documentary on Netflix or writing the great novel of the 21st Century can associate the thought of the bedroom with hyperarousal. It is an extremely useful sleep habit to only use your bed for sleep, but it is also okay to use it for sex and brief reading, if these are calming activities for you.

Finally, to make the bedroom a good place to sleep, it should be cool and quiet (try foam earplugs and a fan), dark (try a sleeping mask, good blinds or curtains), and disconnected from the social world (try removing the TV from your bedroom or not taking phone calls in bed).

There are lots of self-management strategies that can help improve sleep if you live with bipolar disorder. Learning these new behaviours takes some effort – the assistance of a healthcare professional will be helpful in bedding down these new habits. It is also beneficial to discuss your sleep problems with a healthcare provider to rule out possible physiological factors that contribute to poor sleep. Up to 25% of people with bipolar disorder also have obstructive sleep apnea (obstruction of the airway during sleep)²⁰, which is diagnosed by overnight assessment in a sleep laboratory and treated with a continuous positive airway pressure machine. About 10% of people with sleep problems and bipolar disorder have delayed sleep phase syndrome, which often requires specialist support from a sleep clinic. Finally, some medications for bipolar disorder can disrupt your sleep via side effects such as restless leg syndrome²¹, or by making you feel sleepy at inappropriate times. If this happens to you, it’s worth talking to your physician about whether a change to the timing, dose, or type of your medication may be right for you.