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This Is Why Your Mood Might Be Out of Whack

The vital link between routines, rhythms, and bipolar disorder.

Key points

  • Maintaining routine is recognized world-wide as valuable for people with bipolar disorder.
  • Humans have a built-in clock called the circadian system, highly influenced by our lifestyle like our routines.
  • Because the clock is closely linked to mood, if it’s not functioning well, it can generate problems with mood.
  • For people with bipolar disorder, regular wake time may be most important in anchoring routine and therefore mood.
Source: Laura Chouette/Unsplash
Source: Laura Chouette/Unsplash

I’m a regular guest on a webinar series called #TalkBD that provides mental health support and education for people with bipolar disorder (BD). The information can be valuable to everyone, with or with BD. It’s hosted by CREST.BD*, a Canada-based research team of academics, clinicians, and people with lived/living experience of BD. This research team (of which I am a member) is dedicated to spreading knowledge of BD, improving people’s quality of life, reducing stigma, and empowering those of us with BD (like myself) with the tools to help us stay well.

Maintaining a routine is recognized worldwide as valuable for people with bipolar disorder.

Sleep expert Dr. Greg Murray and I came together for this episode called “Routines, Rhythms and Bipolar Disorder” to discuss sleep-wake rhythms and how routines in life can stabilize moods.

Dr. Murray, a clinical psychologist and researcher specializing in the body clock and mood and CREST.BD team member, explains, “Every treatment guideline in the world for bipolar disorder says something like: encourage people with bipolar disorder to maintain daily routines” and is recognized to be really useful for BD.

In his clinical practice, his clients with BD “tend to say ‘my life goes better when there’s structure in it’; ‘my real low points are when there wasn’t enough.’ For example, ‘I was pretty good in (high) school, but things fell apart in university because there wasn’t enough structure’; ‘when I broke up with my partner, some of the routines and daily rhythms I had in the relationship were lost.’”

Why routine matters

Evolution designed every organism, from a flower to a clam to your neighbor’s dog to human beings, to fit as beneficially as possible with the natural rhythm of the environment. You’ll see that in particular with light and dark and the changing of the seasons.

We have a predictive mechanism in us: a built-in biological clock. It wakes us up and prepares us for sleep (by releasing melatonin, a sleep-inducing hormone, for example). It performs this so we can function well in the day and helps us maximize the restorative nature of sleep.

This clock is called the circadian system and works on a 24-hour rhythm. Dr. Murray explains that this clock sits at the level of the forehead, “about 8 cm in, deep in the base of the brain.” Interestingly, it is what some Indian spiritual traditions and other Asian religions call the “third eye.”

This clock is highly influenced by our lifestyles, like our routines, our daily behavior, and rhythms. For example, when we go to sleep, when we get up in the morning, when we get our first blast of light, when we eat, even when we have our first social touchpoint.

“Because this clock is closely linked to mood, if it’s not functioning well, it might generate problems with our mood.”

What is even more important, Dr. Murray tells us, is that “this clock is closely linked to the part of the body, brain, and mind that are about mood. One of the things the clock drives is daily patterns in energy and mood. If that clock is not functioning well, we might generate problems with our mood.”

Things like irregular bedtimes, wake times, and unpredictable social contact can “confuse the clock.” How we act on a daily basis can either support the clock or disrupt it.

It’s hypothesized that people with BD already have a vulnerability with the clock. Supporting this clock is important for everyone but even more vital for those of us with bipolar disorder.

The negative feedback loop

When I have an episode, depressive or manic, my routine turns upside down. My sleep goes wonky; regular meal times become irregular; exercise goes out the window, as does social contact. My mood is already being affected, and my mood affects my behavior, which affects my routine. My routine affects my circadian rhythm, which creates this negative feedback loop.

Routine is vital. I wish I had the flexibility to get up between 7 and 10 in the morning, but my wiggle room really is between 6:45 and 7:30 a.m.

Biology is on our side. With routine, I’ll start to come back into harmony and so will my mood.

I find it encouraging because biology is on our side. If I’m able to get support to create those routines, I know eventually I’ll start to come into harmony with them, and my mood will harmonize eventually, too.

Trust that your mood will improve gradually as your routines become more regular. Don’t expect your mood to turn overnight. Like the slow rise of the sun at dawn, improvement in mood will start.

How do I manage to maintain daily routines?

For me, some of it has been learning the hard way. It’s getting kicked in the butt too many times when I don’t have a routine. I wish it was something easier, but that’s one of the reasons I keep them.

Routine equals freedom.

I’ve had to rethink routine. There’s this idea that routine equals boredom. I’ve tried to re-frame for myself that routine equals freedom.

When I have a routine, I feel surprisingly comforted. I have these checkpoints in my day. I get up at the same time; I meditate. I listen to CBC Radio; I hear a familiar voice; I catch up on the world, so I feel connected to it. I take a walk outside first thing in the morning to get some fresh air and light.

It allows me not to be dependent on other coping mechanisms and frees me up from these really extreme mood cycles. This routine doesn’t feel boring because now I have flexibility which allows me to be creative and socialize. I can go to that party and go to bed late once in a while. I’m not hampered by depression as often, so I’m more creative, not less.

Dr. Murray’s takeaways

1. Nudge things back on track: Be gentle.

2. Try to do behaviors at the same time each day, seven days a week: when you wake up and go to sleep when you eat, exercise, and have some social interaction.

3. Regular wake-up time is the most important behavior to routinize: According to Dr. Murray, “research suggests that for people with bipolar disorder the daily behavior that might be most important in anchoring these routines across days is the time of getting up… a lot of other behaviors flow from that. It has the most muscle for supporting rhythm and the clock.”

4. Think about a sustainable time of day for you to get up seven days a week: See what happens when you aim to stick to that, but don’t do it rigidly.

© Victoria Maxwell

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