Stability in Bipolar Disorder Requires Routine

September 13, 2010 Natasha Tracy

Bipolar disorder stability depends on a routine. Standard routines of sleep, medication, and stress-reduction decreases bipolar episodes. Bipolar routine works.

Bipolar disorder, by its very nature, is not routine. People become manic unexpectedly and people get depressed unexpectedly. And during depression or mania, people become even more erratic in all areas of their lives.

So if bipolar disorder exists outside of a routine, what would happen if routine were applied to bipolar disorder?

Bipolar Disorder Requires Routines, a Strict Rhythm

Your average person has a pretty variable rhythm. People get less sleep on weekdays, go out to a party now and then, not getting to sleep until 2AM, sleep in on weekends, sometimes skip breakfast, drink more and less coffee, work more or less hours and exercise at different times during the day. This is not generally a big deal for people. That’s just part of life.

The problem is that for a bipolar, it’s a very detrimental part of life.

Many of us with bipolar, not to mention the people around us, have noticed that breaks in rhythm result in bipolar episodes. Most noticeable is changes in sleep, life changes and stress leading to episodes. Studies have borne out this observation. A change in life routine does, in fact, often precede an episode like hypomania or mania. A therapy (Social Rhythm Therapy) was designed to address just these points.

What Does Routine Mean in Bipolar Disorder?

I have found the single most important part of attaining and maintaining any sort of stability is keeping a routine. It is highly inconvenient, but nothing causes problems more than varying from it.

Here are some of the factors that should be controlled:

  1. Sleep – go to get at the same time every night and get up at the same time every day – in my opinion this is most important thing you can do for yourself. Even staying up late one night can increase the likelihood of an episode.
  2. Medications must be taken at exactly the same time every day in order to keep a steady blood-level of medication (it goes without saying, keep all doctor's appointments).
  3. Control stress – yup, everybody gets stressed. The important part is trying to avoid stress, lessen it and find ways to deal with it when it comes.
  4. Put effort into maintaining social relationships whenever possible.
  5. Get sunlight everyday – get a sunlamp if outdoor sun isn’t possible.
  6. Work consistent hours – shift-work should be avoided.
  7. Exercise every day – this can just be a 15 minute walk, honestly, even that can help.
  8. Eat a balanced diet – if you don't fuel your brain, it's natural that it would be upset
  9. Create a daily routine where as many pieces of your day as possible happen at the same time every day.
  10. Don’t drink (or take other drugs). Just don’t.

You may find other factors that are important for you.

Strict Routines Suck

Yes, they do. I can’t tell you how much I hate doing it every day of my life. But that doesn’t mean it isn’t worth it.

Is It Really Necessary to Control So Many Things?

In a word, yes. Bipolar disorder is a serious illness that destroys lives. It keeps people from working, it gets people fired, it breaks up relationships, it ruins friendships and on and on. So yes, it’s worth putting structure into your life to try to avoid those things, not to mention to avoid all the suffering you, personally, would undergo.

The Great Thing About a Routine

And here’s the best thing about creating a routine in your life – it’s a drug-free therapy. You can even do it without professional help. In a world of side-effects, toxicity, blood tests, weight gain and co-pays, that sounds like a really good treatment option to me.

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

APA Reference
Tracy, N. (2010, September 13). Stability in Bipolar Disorder Requires Routine, HealthyPlace. Retrieved on 2024, July 19 from

Author: Natasha Tracy

Natasha Tracy is a renowned speaker, award-winning advocate, and author of Lost Marbles: Insights into My Life with Depression & Bipolar. She's also the host of the podcast Snap Out of It! The Mental Illness in the Workplace Podcast.

Find Natasha Tracy on her blog, Bipolar BurbleTwitter, InstagramFacebook, and YouTube.

Shannon Marie
September, 13 2010 at 8:19 am

Natasha I love you.
You are the Bipolar Whisperer.
I am currently working on my routine and time management. I will not let BP steal all my time! Because it can be so overwhelming, I use lists and systematically knock things off it one at a time. It helps to take this one in bites. The importance of routine cannot be overstated.

Natasha Tracy
September, 13 2010 at 8:22 am

"You are the Bipolar Whisperer."
I may steal that. Thanks.
- Natasha

Shannon Marie
September, 13 2010 at 1:18 pm

hehehe....I crack myself up.
you've earned the title, love!

Natasha Tracy
September, 13 2010 at 5:00 pm

You crack me up too. I love that.
- Natasha

September, 14 2010 at 4:59 am

You are SO right. Routine is king for Bob, and it makes all of our lives easier. Obviously, life doesn't always adhere to the routine, and that creates some challenges, but the more I can keep his life as routine as possible, the better he is.

September, 14 2010 at 7:06 am

You've got great suggestions for bipolar.
I specifically when into nursing not only to help other people, but because I couldn't stand regularity. I grew up in an abusive, neglectful, unstable environment because my parents couldn't handle parenting - I lived in 11 different homes with different family members until I met my husband at age 16 - over 30 years ago. Since then I've had complete stability and unconditional love, but the dislike for routine was already ingrained in me.
But that has affected my special needs mentally ill son - he couldn't get the consistancy he needed (even though he has love, food, stable home and school), I could never remain consistant with all the millions of "consistancy" suggestions I was told by the experts I had to do. Both he and I are much more ill because of each other. I am now too burnt out and hands off with him, but my husband has taken over and able to supply him with the constancy that he needs.
With my son, the home environment is so toxic as we all sit on eggshells waiting for the next crisis and explosion. The stress never ends, adversity lives in my home and won't leave. I've even stopped exploding in frustration when things go wrong because it's become a constant fixture and almost expected, or I am un-surprised when I'm knocked off my feet again - the death of both parents and a brother-in-law, car accidents, ambulance calls for my 10 year old for accidents while on outings, constant flu's, illnesses further stopping and disrupting our lives, and broken appliances, plumbing, electronics over and over one after the other - it's actually comical. So no freedom from stress.
I miss not being able to drink my peach cidar. It now puts me into a further depression that lasts for days, so no alcohol. My 10 year old daughter is so traumatized she sleeps with us and I have to go to bed with her every night at nine o'clock.
We can't go anywhere as a family or have anyone over due to my son's illness - he can't tolerate it and it puts him over the edge. We can't even eat dinner together at the table. I can't cook for anyone because they all hate everything. Meals are one rejecting disaster after another. A total nightmare.
I had one manic episode last year which I guess confirms the diagnosis of bipolar disorder - difficult to accept. I want the doctor to do ECT because all of the drugs no longer help my depression, but he won't because he says it's from my home environment and feels my son should be in a foster home. Not on your life!! We don't know if he's bipolar, schizo. or what - right now it is definately psychosis.
My one manic episode was great because I got all those intolerable, boring tasks off my lists - I made about 25 pages of lists. But it was followed by a severe crash of depression, because the manic energy robbed the energy and I had to pay it back. It was probably never would have surfaced had it not been for all the stress. I became extremely ill on the Epival and Lithium. The Lamotrigine doesn't appear to help the depression, although I finally stopped feeling suicidal last January. And in that suicidal state, I lost all rational thought of what a suicide could do to my children and family. The only thing I had to go on is the fact that I'm a psychiatric nurse and I knew to sedate the heck out of myself until the extreme emotion passed.
So I've now run out of options, except I was well enough to end the 18 month medical leave I had to take and return to work. And possibly I'll become well again in around 6 years when I am no longer legally responsible for my son's care - however my husband refuses to abandon his ill son, I hope my daughter and I don't have to move out - what a horrible fate to give my husband - to force him to choose between his extremely ill son, or his less ill wife and normal daughter. I hope it never comes to that.

Natasha Tracy
September, 14 2010 at 5:24 pm

Hi Angela,
Yes, all children need routine, but ill children _need_ it like they need oxygen. It's great that you've noticed that and see the importance. It's something that no one seems to tell you about.
- Natasha

Natasha Tracy
September, 14 2010 at 5:33 pm

Hi Lori,
Thanks for sharing your story, I hope some of what you read here helps.
It sounds like you're in a really tough situation. The only thing I can tell you is that it sounds like you might find life-skills-type-therapy helpful. For people in a chaotic environment, this type of therapy aims to give you the skills to handle it and even change it. There are many different types, your doctor should be able to help you. CBT or DBT type therapy also might help.
If you can help yourself and your son with life changes, it's much better for both of you than medication or ECT. Believe me.
Good luck.
- Natasha

September, 15 2010 at 6:06 pm

Brilliant advice, so simple and seemingly obvious.Thanks for posting.

Natasha Tracy
September, 16 2010 at 8:08 am

I believe it was Einstein who said, make everything as simple as possible, but not too simple. I like that. Simple things are easier to remember.
- Natasha

September, 16 2010 at 8:52 am

thanks for your kind responses, and for bringing up your suggestions.
It's all part of the parcel and you wouldn't know it, but I counsel my patients about it all the time. I try to practice it when I remember - meditation, self-hypnosis, CBT, massage, EFT (tapping), mindefulness, praying, excercise, nutrition, self-soothing techniques such as epsom salts baths (water is a great healer).
I've taken courses/seminars at the hospital on depression and anxiety referred by the mental Health team (I live in British Columbia, Canada), and I've taken seminars on the same as a psychiatric nurse to help my patients - I am good at teaching and inspiring others, but my illness plus the time necessary for my distraught family does not allow me to follow all of my own advice.
My state of mind is better today although I am home nursing my psychotically ill child. I will have to cancel work tomorrow to care for him. Work has been my biggest life saver, mood brightener, but not for tomorrow.
And yes, simple, simple, simple! When it get's overwhelming, drop everything and all expectations of yourself! All will survive when you've gotten yourself off that hamster wheel and. It helps when in those darkest areas of depression to say STOP! You don't have to do anything, you can drop those expectations, and you don't have to worry and fret about those extreme painful and worrisome emotions. It is just the depression telling you lies and altering your perception - they are not facts, they are not truths. Just a pair of gray colored glasses the depression has placed on you.
In giving yourself that break from all that guilt (lies from the depression again) and expections of how you should feel, how you want things to be different, you take a lot of pressure off yourself and it recharges the mind by giving yourself permission to just be, warts and all.
For any of you that don't know about it, check out "The Changeways Program" - It's appropriate for anybody, was started by Psychologist Randy Paterson from Vancouver General Hospital, has gone worldwide, is offered in many languages - I teach it but forget to practice it, as I always say, you can take what you want from it and leave the rest.

nurse practitioner
September, 27 2010 at 5:52 am

My cousin recommended this blog and she was totally right keep up the fantastic work!

October, 2 2010 at 4:10 am

I have tried god knows how many times to keep a routine, but it never ever works for me. It's great that you wrote this and honestly it seems so common sense, but it's easier said than done. Usually when i'm in a hypomanic state I can create a schedule, but 3 or 4 days later I spiral down and bye-bye lil' routine!
Good post though.

Natasha Tracy
October, 2 2010 at 8:08 am

Hi Wes,
Maybe during hypomania isn't the best time to start. Perhaps start when you're more stable, and try something small. Don't try to regulate your life all at once or you'll be much less likely to succeed.
- Natasha

October, 22 2010 at 7:51 pm

I just signed up to your blogs rss feed. Will you post more on this subject?

Natasha Tracy
October, 25 2010 at 9:17 am

Hi badmash,
That's certainly a possibility. I generally keep a list of requested topics and write about them as the mood strikes. I'll put this one on the list.
- Natasha

June, 23 2012 at 3:15 am

I'm so thankful that I found your blog. I have stumbled onto the most stressful time in my life, and I've been diagnosed as Bipolar Disorder I since I was 9. Three months ago I found out that my husband had enough with dealing with me. Our marriage had been on the rocks for 2 years and we had tried desperetly to heal it, for our daughters sake, but to no avail. We finally decided that it was healthier for her if we split up. Since then I went into full mania. My daughter went to live with my mother (per my request) and I was left alone in an empty house. Which, for Bipolar people, we all know can be detrimental to be alone during any depressive or severely manic episode. It's not smart. I then discovered energy drinks, which I really feel necessary to share because of the scary tole that it took on my body.
March 1 I discovered Monster Energy drinks and 5 Hour Energy Shots. Since going into full mania after my husband left and my daughter went to live with my mother, I was desperate to find some relief and instead of turning to drugs and alcohol ( bc that scares me and I know it's super unhealthy for Bipolar people, no one told me about caffeine), I turned to energy drinks which would in turn further increase my instability and mania and pushing me further and further into quite possibly the biggest crash of my life. I like the Mania episodes solely for the energy it brings, bc productiveness is like an addiction to me, the more productive I am, the more needed and wanted I feel. Which for me, rejection is a HUGE issue and usually pushes me into a depressive episode. So the productivity I experience in Manic episodes is like a drug to me.
Two weeks ago, I went to the doctor with seriously horrible migraines, stomach pain, back pain, nausea, vomiting, and an ending diagnosis that scared me to death. he ran some tests and found, of course, that the energy drinks had given me a horrible UTI and that's where all the stomach pain was coming from, but what he told me next I was HIGHLY unprepared for. The high amounts of caffeine I had been intaking for over three months had affected my brain and the chemicals in it so negatively that the Norepenephrine, Dopamine, and Seratonin had become so sluggish and thick due to the high amounts of caffeine that I had been having, that they were unable to travel through the Nuerotransmitters in my brain to reach all Lobes of my brain. I had only had access to the Frontal lobe of my brain and it had left out the Temporal and Occipital Lobes. Not only was I not using all of my brain, the Caffeine had caused my brain to swell to try and overwork itself and get those chemical to the rest of the brain. I almost lost my job, my family, my child, and my life. Because, come to find out, the most common side effect of Caffeine to Bipolar people is suicide.
Now that I'm off Caffeine, my life has turned around DRASTIALLY!! My boss even came up to me and asked me how I did I turned my entire demeanor around in less than two weeks. I'm now, in two weeks time, in line for a promotion and better hours and just got a raise! Please, if you have Bipolar Disorder, head my advice and stay away from caffeine. It nearly ruined me!!

Natasha Tracy
June, 24 2012 at 9:24 am

Hi Jessica,
Thank-you for sharing your experience with everyone. I'm sure that others have benefited and can identify.
Just to clarify, caffeine is not actually harmful to bipolar disorder IF
- used in moderation
- you're not prone to psychosis
- you're not manic
- you're not prone to anxiety
I just want to clarify this so people don't think that a cup of coffee in the morning is harmful. However, you are absolutely right that large amounts of caffeine - which is a _drug_ - can be harmful.
- Natasha

October, 27 2012 at 5:20 pm

Natasha. It's taken me two years to find you and a desperate attempt to find relief from the depresion I'm in at the moment. You are the "Bipolar Whisperer" - You should be all over that, write a book! Or change the name of your blog :) I just couldn't wait to let knew you after reading through a few of your posts, you have brought me a considerable amount of relief. You echo my thoughts, my feelings, my experiences - while I'm not happy that you have to deal with bipolar, bipolar, bipolar - what you are doing on this blog is helping so many people, especially me. Love your over-identification post. That's how I feel, exactly, everyday!!! Thank you from your newest and greatest fan!

January, 23 2014 at 4:54 am

I myself live with bipolar and have for years. I never thought in my life that I could ever feel happy, sad, motivated, fearful, pissed, outraged, my job and relationship was horrible and in termoul every day all day! I have a 13 yr old son I have practically raised on my own since he was 1. I came from a horrible maraige of drugs, lies, alcohol and mental and physical abuse. I got out of that and BAM! 2 yrs later I fell in love, head over heels. We moved in together and had a simple but nice relationship, I was his everything but never really knew it. He worked 24/7 and was even on call when he got home, when ge did get home he'd fall asleep from exhaustion. I always felt alone or not loved. This went on, on and off for 9 yrs. we were supposed to get married but due to an unfortunate event the wedding was cancelled after everything was set to happen. The day I had waited on forever!! We then had to move I. With his mom and stepdad which at first I enjoyed but it threw me into a depression. I slept all the time and we grew apart, but nobody understood what I was going threw. I moved back in with my parents and tried to move on but we just kept going back and forth with eachother, it broke my soul and heart. Finally we gave up. I'm also in the army reserves as well as being a nursing asst. four yrs ago this April I finally fell in love again and harder. I met my boyfriend while living with my father, and for over a yr I have been residing with. On our first date he told me he had multiple sclerosis, and yhst he has had it for 11 yrs. I smiled and told him that didn't bother me that everyone deserved loved no matter what. We have been together ever since, but it has been no cake walk. He had been on numerous medications that didn't work, then finally had to go on an infusion every monthhe he got at the cancer center. That drug did wonders for over a yr, but because of the beginning stages of a virus he was getting that could cause a deadly brain infection and kill him he had to go off of it. So now back to square one. Before all this he lost his father to a sudden bought of cancer and he just got over his 2nd hip replacement in nov. We have fought, yelled, screamed, slammed doors and knocked things off tables. I have packed my stuff and threatened to leave and he has threatened to throw me out. This yr has been horrible, all of this has happened to him in the past yr with his dad only being gone 8 months. We both are depressed and kind find the light at the end. I'm always there to hold him up and be strong, but because of his illness don't always get in return when I need it. Bi polar is horrible. It makes me yell and scream when an argument arises and then the crying hits. I just want to choke someone when I get that way. He infuriates me. I'm surprise we have lasted this long and am worried when the end might come for us if things don't change. My uncle who knows a lot about medications and holistic things told me about a medication that is sold in vitamin shops, but I found it in kmart/cvs. It's called hydrotryptophan. Its a precursor to serotonin, a neurotransmitter involved in sending signals to the brain that contribute to well being. It helps support a calm and relaxed mood, and helps maintain a positive outlook. Most people who have bi polar are low on serotonin, that's why the bi polar reacts. This pill 5-htp is suppose to even out the levels in your body because it levels out the serotonin. Every place I looked there was only 1-2 bottles left of it. It is said to be a very common, popular medication consisting of natural ingredients. But of course consult your doctor if on any other medications before taking it. I started it yesterday so I'll see!

May, 4 2014 at 7:16 pm

This blog is helpful. It helps to find ways to cope up with bipolar.

July, 23 2014 at 8:36 am

By all means realize that you are bipolar, get disciplined and stay disciplined, avoid stress at all costs. If you need love get a dog. Its a lonely life but you have a major disorder and have to do whatever is necessary to stay stable.

June, 16 2015 at 1:04 am

I agree with routine but im gonna have to say medication is wayyyy better at controling moods and keeps me almost mood swing free im type1 rapid cycling with lamotrigine my life is totally different lately ive been getting mood swings time to up the dosage 150mg a day was a good starter

February, 11 2016 at 1:51 pm

Can you give advice about handling a depressed brother who won't follow doctor's or therapist's advice? He is miserable, nasty and makes me very nervous. I have tried helping him over the last 8 years. He has become much worse. I can no longer be a surrogate therapist or soundboard. He makes my Bipolar worse.

Fran Growall
June, 3 2016 at 6:01 pm

I've given up on this. My brain just won't work that way. I shoot for basic needs and getting one to three things or progects worked on. I must take my time and be in the moment. This isn't the real world? Welcome to my world.

April, 29 2019 at 4:26 am

This is the best advice anyone with bipolar could take. I do all these things and I've been stable for 10 years now:)
Brilliant x

May, 27 2019 at 5:30 pm


Leave a reply