For just about everyone, routine provides a sense of stability and promotes achievement. For the person with bipolar disorder, maintaining a daily routine can be a vital strategy to normalize mood. By contrast, days filled with surprises can trigger bipolar episodes. Following a daily schedule is so helpful that an entire therapy has been built around the idea. Interpersonal and Social Rhythm Therapy (IPSRT) is a blend of cognitive behavioral therapy and interpersonal psychotherapy that drives home the importance of sleep – a huge issue for everyone, but especially so for people with bipolar. The therapy requires patients to journal their mood throughout the day in order to discern patterns so the therapist and patient can work together to identify daily routines. Every living thing is inherently attuned to the light and dark cycles that make up our days. This inner clock is known as circadian rhythm. Adhering to the day/night cycle and getting appropriate rest has been shown to improve mood and function during waking hours. Since managing sleep cycles is so helpful in managing mood and bipolar symptoms, anything that contributes to a predictable sleep-wake cycle is a good thing. Sleep disturbances are one of the chief causes for manic episodes. Here are some practical steps a person can take toward regular and restful sleep:

1. Go to bed and wake up at set times. This will mean making choices, especially if friends and family aren’t headed to bed at the same time. The body will eventually conform to a sleep schedule if it is routinely followed.
2. Help yourself unwind and prepare to rest. When there is an evening pattern the body gets the signal that bedtime and sleep are approaching. Evening habits could be anything from watching a certain television program to reading for a set amount of time. Personal care habits like brushing teeth and hair, taking a warm bath or washing the face with a warm washcloth all send the message that it’s time to relax.
3. Anxieties can keep people awake. Have a strategy like writing down troubling concerns in a notebook. People of faith may express their worries in prayer. Once the brain has dealt with the anxiety in some form it becomes easier to set aside.
4. If anxiety persists, try focusing on breathing. This doesn’t mean you need to change how you breathe, simply give it your full attention. Count each breath – inhale and exhale – to 10 and then start again until you feel at peace.
5. Listen to soothing music. Music that relaxes the soul without engaging the mind is best. Choose instrumental pieces or music that blends orchestration with sounds from nature. You want the benefits of music without the distraction of lyrics.
6. Protect your sleep environment. Clean sheets and a comfortable bed invite rest. Temperature can also affect sleep, so do what is needed to make the bedroom a pleasant atmosphere. Eliminate all ambient light (cell phones, computers, digital clocks, television) as even a small amount of light can confuse the body. Control noise with a white noise machine or electric fan.

It’s important to have a schedule or routine during the day as well. Having too much unstructured time can lead to depression. A full-time job will give structure to each day, but if you work part-time, develop some routines to make those hours productive as well:

• Do needed housework
• Volunteer
• Schedule lunch or coffee dates
• Have a regular exercise plan
• Walk the dog
• Attend support group meetings
• Phone friends/write letters.

Medication is another part of a healthy routine. Whatever it takes to regularly take meds is vital. Cell phone alarms or segmented pill boxes can aid memory and routine. Bipolar disorder can make a person feel victim to their own emotional roller coaster. IPSRT helps patients regain some control over mood swings. It’s remarkable what a difference can be achieved through something as small as following a daily routine.