Bipolar treatment usually consists of medicine as the first line of attack, but medicine alone rarely gives you back the life you had intended to lead. You might already be arranging your cocktail of medicines as I have recently written about.

There is one key action you can take yourself to maximise your quality of life. Studies have shown that a Rhythm in your daily Routine can help people stay well longer. This "R&R" duo is not widely understood yet and many older manic-depressives (such as me) have had to discover it for ourselves. This article offers you a shortcut to using rhythm-in-routine to improve your health.

Social rhythm disruption has been shown to be significantly linked to the onset of manic episodes (1). Having friends to stay for the weekend can be enough to bring on symptoms. Sufferers of bipolar disorder have vulnerable body clocks, and protecting these appears to be of benefit (2).

Because the body clocks of people with bipolar disorder are quite sensitive, events that disrupt daily routines and sleep-wake cycles are associated with becoming ill again. Dr Ellen Frank and colleagues have tested the idea that helping people adopt regular wake times, bedtimes, mealtimes, and other routines could protect patients from new episodes.

They developed a treatment called "interpersonal and social rhythm therapy," which attempts to help the person develop and maintain regular daily routines. It is almost impossible, however, to impose daily routines on a chaotic life. A life without rhythm is a chaotic life. How much chaos or boredom are you in? Overstimulation such as being in a new relationship, can lead to mania, while understimulation can lead to depression (3). While this looks like a no-brainer, any chaotic lifestyle element can bring on symptoms.

RHYTHM VERSUS CHAOS-BOREDOM

I suggest we try to transform chaos and boredom into some rhythm before we put our daily routines in order. Chaos can be the result of over-stimulation and/or a lack of routines. Spend some time mulling over the last month or so. Capture situations that have typically been over-stimulating. Was there a rush? Or perhaps some bodily sensations of the fight-or-flight response?

It is important to recognise that there is a real thrill, an actual adrenalin rush, in some states of bipolar disorder that can be quite addictive. If you get rid of the chaos you could be robbed of the rush. You can replace this by adding some rhythmic exercise to your daily and weekly routines. Try fast walking, running, cycling or swimming and let the natural feel-good endorphins do their job.

Next, muse on your bored times. Perhaps, like me, you have created much to do lest you become bored. (In that case, drop some of your activities for a while). If there are periods during the day when you are so under-stimulated that you feel like screaming, try to add some stimulus. Listen to the world news rather than the same hit songs over again while you travel to work or school. Do a crossword, or anything that lifts your interest level a little.

Is there any one of your daily situations that is typically chaotic? I suggest starting with a simple one for practice then tackling the most chaotic one. I became stressed at the mountains of toys, newspapers, mail, small tools, staplers, phones, dirty coffee cups etc on the kitchen table. To tackle this, I started using a tablecloth. This meant that every evening the table had to be cleared. I admit that I was the one who cleared the table, but without the flotsam and jetsam we could have a more relaxing dinner.

The next task is to tackle the worst stressor in your daily life. For me it was accompanying my partner drinking at night. Needless to say this ended in fights, an anxious child and a great deal of hurt. Not only that, I found I couldn't think as clearly as I needed to, and I had no time for hobbies such as sewing. All of this resolved when I stopped drinking every night.

So select your target chaos, and identify what you can do to reduce it or escape it. Remember you can't change anyone else, only yourself and your actions. When you've won over the chaos, resist being drawn into something equally chaotic!

ROUTINES

Once you have reduced the main chaos in your daily life, you will have a good chance of sticking to a routine.

Researchers have defined daily routines in terms they can measure, for example, waking time, time of first social contact, time of starting work, school etc, dinner time and bed time. In real life there are other routines, such as what you do after dinner, routines with the children and so on.

Setting a waking time with an alarm clock is easy enough to say, but if you don't have a regular bed time your body clock will not be happy: too much sleep one night followed by not enough sleep three nights in a row. I suggest starting by setting a bed time and seeing how much sleep your body actually needs. Then you can set a waking time and have a good chance of sticking to it.

Shift work, particularly the sort that has early mornings, afternoons and sleepovers all mixed in, is dynamite for manic-depressives. If you think your peace of mind is being upset by your shift work, now might be a good time to investigate other jobs in your field, or even studying to change fields. There are no sacred cows when it comes to your health!

Changing a dinner time can be difficult if other household members can't be there. Here, compare yourself to someone with diabetes whose doctor has said they must eat at regular intervals. Your health would come first as a diabetic, so why not give bipolar disorder the same importance? There are always ways...

When you make a change to your routines, persist until you can recognise the benefits.According to the research you can expect to be in good health for a longer than usual period.

Finally there is more to routine than daily routines. Weekly routines such as playing sport or going to church can expand your sense that you live in a predictable world. The weeks tend to lap over each other in a very reassuring way.

To summarise,

• Deal with chaos first, then adopt routines
• Identify chaotic situations or over-stimulation
• Practise reducing chaos on a fairly easy situation
• Tackle the most chaotic situation
• Set a bed time first, then a waking time
• Eat at the same time every evening
• Take up an activity that happens at the same day and time every week
• Make notes of your discoveries to reinforce your new arrangements

Go well, and go slowly. With the right medicine, reduction of chaos and the introduction of routines, you're bound to be healthier for longer.

Footnotes

1. Malkoff-Schwartz and colleagues, 2000

2. Frank and colleagues, 2006

3. Frank and colleagues, 2006

Madeleine Kelly is the author of the award-winning book Bipolar and the Art of Roller-coaster Riding (Two Trees Media ISBN 0-646-44939-7). More information about managing bipolar disorder can be found at http://beatbipolar.com

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Bipolar and the Art of Roller-coaster Riding

By Madeleine Kelly

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